# LIFE CHANGE RX 4 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Life Change Pharmacy 4
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558906354
- **Authorized official:** ALI A ALI R.PH (PHARMACIST / OWNER)
- **Authorized official phone:** (414) 999-0999

## Contact information

- **Practice address:** 6300 N 76TH ST STE 246, MILWAUKEE, WI 53218-1208
- **Practice address phone:** (414) 999-0999
- **Mailing address:** 1844 S 15TH ST, MILWAUKEE, WI 53204-3225
- **Mailing address phone:** (414) 999-0999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2019
- **Last updated:** 11/15/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 961842 | WI STATE BOARD OF PHARMACY | WI |