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Contact Information

LIFESPAN PHARMACY, LLC
593 EDDY ST
DAVOL BUILDING
PROVIDENCE, RI02903-4923
 Phone: 401-444-4909
 Fax: 401-444-2263
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Specialty Pharmacy

3336S0011X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for LIFESPAN PHARMACY, LLC

NPI Number 1154668077
LBN Legal business name LIFESPAN PHARMACY, LLC
Authorized official PETER MARKEL - (EVP & CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 01/11/2013
Last updated 09/24/2024 - More than a year ago
Identifiers
RI License # PHA00549
MA Medicaid 110066635C
RI Medicaid LI92510
Other 2138499 PK
MA Other 2138499 MEDICAID
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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