# LIFE CHANGE RX 1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Life Change Pharmacy 2
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952965576
- **Authorized official:** ALI A ALI (C-OWNER)
- **Authorized official phone:** (414) 600-2000

## Contact information

- **Practice address:** 7115 W CAPITOL DR, MILWAUKEE, WI 53216-2051
- **Practice address phone:** (414) 600-2000
- **Practice address fax:** (414) 600-0414
- **Mailing address:** 1844 S 15TH ST, MILWAUKEE, WI 53204-3225
- **Mailing address phone:** (414) 600-2000
- **Mailing address fax:** (414) 600-0414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2019
- **Last updated:** 01/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100071374 | — | WI |