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Organization
LIFE CHANGE RX 1 LLC
Active
Organization
LIFE CHANGE RX 1 LLC
Active
Other names
Life Change Pharmacy 2
Organization subpart
No
Provider details
NPI number
Authorized official
ALI A ALI (C-OWNER)
(414) 600-2000
Entity
Organization
Contact information
Practice address
7115 W CAPITOL DR, MILWAUKEE, WI 53216-2051
(414) 600-2000
(414) 600-0414
Mailing address
1844 S 15TH ST, MILWAUKEE, WI 53204-3225
(414) 600-2000
(414) 600-0414
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071374
—
WI
Enumeration date
04/29/2019
Last updated
01/15/2021
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