Provider Demographics
NPI:1962244657
Name:LIFELINE PHARMACY INCORPORATED
Entity type:Organization
Organization Name:LIFELINE PHARMACY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-314-0270
Mailing Address - Street 1:1807 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3515
Mailing Address - Country:US
Mailing Address - Phone:845-314-0270
Mailing Address - Fax:845-314-0245
Practice Address - Street 1:1807 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3515
Practice Address - Country:US
Practice Address - Phone:845-314-0270
Practice Address - Fax:845-314-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy