# LIFE GATE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558788760
- **Authorized official:** MS. MICHELLE HERZOG (OWNER)
- **Authorized official phone:** (708) 557-3155

## Contact information

- **Practice address:** 5241 S CICERO AVE, CHICAGO, IL 60632
- **Practice address phone:** (708) 557-3155
- **Practice address fax:** (773) 284-6431
- **Mailing address:** 8559 W 121ST ST, PALOS PARK, IL 60464-1230
- **Mailing address phone:** (708) 557-3155
- **Mailing address fax:** (727) 474-9067

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 036059796 | IL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016003225 | IL | Yes |

## Other

- **Enumeration date:** 03/25/2014
- **Last updated:** 09/17/2018