Provider Demographics
NPI:1285278978
Name:LIFE CHANGE RX 3 LLC
Entity type:Organization
Organization Name:LIFE CHANGE RX 3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:EL SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-335-4617
Mailing Address - Street 1:1844 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3225
Mailing Address - Country:US
Mailing Address - Phone:414-999-0999
Mailing Address - Fax:414-562-6888
Practice Address - Street 1:7115 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2051
Practice Address - Country:US
Practice Address - Phone:414-999-0999
Practice Address - Fax:414-562-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy