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Organization
LIFE TREE PHARMACY SERVICES INCORPORATED
Active
Organization
LIFE TREE PHARMACY SERVICES INCORPORATED
Active
Other names
Life Tree Pharmacy Services Incorporated
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TAGLIANETTI (PRESIDENT)
(610) 489-6640
Entity
Organization
Contact information
Practice address
5 BLUE HERON DR, COLLEGEVILLE, PA 19426-2057
(610) 489-6640
(610) 489-6645
Mailing address
5 BLUE HERON DR, COLLEGEVILLE, PA 19426-2057
(610) 489-6640
(610) 489-6645
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336I0012X
Institutional Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PP481454
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013015200001
—
PA
01
—
2085292
PK
—
Enumeration date
06/20/2006
Last updated
07/17/2019
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