# LIFE TREE PHARMACY SERVICES INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Life Tree Pharmacy Services Incorporated
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760428684
- **Authorized official:** MARK TAGLIANETTI (PRESIDENT)
- **Authorized official phone:** (610) 489-6640

## Contact information

- **Practice address:** 5 BLUE HERON DR, COLLEGEVILLE, PA 19426-2057
- **Practice address phone:** (610) 489-6640
- **Practice address fax:** (610) 489-6645
- **Mailing address:** 5 BLUE HERON DR, COLLEGEVILLE, PA 19426-2057
- **Mailing address phone:** (610) 489-6640
- **Mailing address fax:** (610) 489-6645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PP481454 | PA | Yes |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 07/17/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1013015200001 | — | PA |
| 01 | — | 2085292 | PK | — |