# LIFE CHANGE RX LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Life Change Pharmacy 1 Long term care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205544913
- **Authorized official:** ALI AHMED NAFEA ALI R.PH (CO-OWNER)
- **Authorized official phone:** (414) 999-0999

## Contact information

- **Practice address:** 1844 S 15TH ST, MILWAUKEE, WI 53204-3225
- **Practice address phone:** (414) 999-0999
- **Practice address fax:** (414) 562-6888
- **Mailing address:** 1844 S 15TH ST, MILWAUKEE, WI 53204-3225
- **Mailing address phone:** (414) 999-0999
- **Mailing address fax:** (414) 562-6888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/10/2022
- **Last updated:** 11/10/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100071374 | — | WI |