# LIFETIME PHARMACY, LLC

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

## Provider details

- **NPI number:** 1831998467
- **Authorized official:** HASSAN FAKIH PHARMD (OWNER/PIC)
- **Authorized official phone:** (574) 318-4195

## Contact information

- **Practice address:** 212 W EDISON RD STE A, MISHAWAKA, IN 46545-8301
- **Practice address phone:** (574) 318-4195
- **Practice address fax:** (574) 318-4936
- **Mailing address:** 19120 OAKMONT SOUTH DR, SOUTH BEND, IN 46637-3529
- **Mailing address phone:** (313) 828-2794

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/07/2025
- **Last updated:** 03/07/2025