# LIFESPAN PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brown University Health Pharmacy, Lifespan Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154668077
- **Authorized official:** PETER K MARKEL (EVP & CFO)
- **Authorized official phone:** (401) 444-7914

## Contact information

- **Practice address:** 593 EDDY ST, DAVOL BUILDING, PROVIDENCE, RI 02903-4923
- **Practice address phone:** (401) 444-4909
- **Practice address fax:** (401) 444-2263
- **Mailing address:** 593 EDDY ST, DAVOL BUILDING, PROVIDENCE, RI 02903-4923
- **Mailing address phone:** (401) 444-4909
- **Mailing address fax:** (401) 444-2263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHA00549 | RI | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/11/2013
- **Last updated:** 09/24/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110066635C | — | MA |
| 01 | — | 2138499 | MEDICAID | MA |
| 01 | — | 2138499 | PK | — |
| 05 | — | LI92510 | — | RI |