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Organization
LIFE SPECIALTY PHARMACY, INC
Active
Organization
LIFE SPECIALTY PHARMACY, INC
Active
Other names
Life Specialty Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL AYOTUNDE (PHARMACIST)
(407) 522-5683
Entity
Organization
Contact information
Practice address
1507 PARK CENTER DR, SUITE 1L, ORLANDO, FL 32835-5795
(407) 522-5683
(407) 522-5684
Mailing address
1507 PARK CENTER DR, SUITE 1L, ORLANDO, FL 32835-5795
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH23699
FL
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1042009
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/04/2009
Last updated
04/29/2009
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