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Organization
LIFESPAN PHARMACY, LLC
Active
Organization
LIFESPAN PHARMACY, LLC
Active
Other names
Brown University Health Pharmacy, Lifespan Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PETER K MARKEL (EVP & CFO)
(401) 444-7914
Entity
Organization
Contact information
Practice address
593 EDDY ST, DAVOL BUILDING, PROVIDENCE, RI 02903-4923
(401) 444-4909
(401) 444-2263
Mailing address
593 EDDY ST, DAVOL BUILDING, PROVIDENCE, RI 02903-4923
(401) 444-4909
(401) 444-2263
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHA00549
RI
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110066635C
—
MA
01
—
2138499
MEDICAID
MA
01
—
2138499
PK
—
05
—
LI92510
—
RI
Enumeration date
01/11/2013
Last updated
09/24/2024
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