Provider Demographics
NPI:1154719128
Name:LIFE TREE PHARMACY SERVICES INCORPORATED
Entity type:Organization
Organization Name:LIFE TREE PHARMACY SERVICES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGLIANETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-489-6640
Mailing Address - Street 1:1996 EWINGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3310
Mailing Address - Country:US
Mailing Address - Phone:412-269-8605
Mailing Address - Fax:610-487-0748
Practice Address - Street 1:1996 EWINGS MILL RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3310
Practice Address - Country:US
Practice Address - Phone:412-269-8605
Practice Address - Fax:610-487-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4825333336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149471OtherPK