# LIFE TREE PHARMACY LLC

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

## Provider details

- **NPI number:** 1649706714
- **Authorized official:** BENJAMIN ENERIAKPOZI EZEKIEL (PHJARMACIST-IN-CHARGE)
- **Authorized official phone:** (414) 698-5044

## Contact information

- **Practice address:** 8329-5 W APPLETON AVE, MILWAUKEE, WI 53218
- **Practice address phone:** (414) 698-5044
- **Mailing address:** 5450 W GREEN TREE RD, MILWAUKEE, WI 53223-5289

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 9459-42 | WI | Yes |

## Other

- **Enumeration date:** 05/10/2017
- **Last updated:** 05/10/2017