Provider Demographics
NPI:1962517169
Name:LIFECHEK HUNTSVILLE LLC
Entity type:Organization
Organization Name:LIFECHEK HUNTSVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-3940
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-2330
Mailing Address - Country:US
Mailing Address - Phone:979-627-7271
Mailing Address - Fax:979-627-7052
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-2330
Practice Address - Country:US
Practice Address - Phone:979-627-7271
Practice Address - Fax:979-627-7052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX237533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2103932OtherPK
TX466104Medicaid
5422500001Medicare NSC