Organization
LIFE CHANGE RX LLC
Active
Other names
Life Change Pharmacy 1 Long term care
Organization subpart
No
Provider details
NPI number
Authorized official
ALI AHMED NAFEA ALI R.PH (CO-OWNER)
(414) 999-0999
Entity
Organization
Contact information
Practice address
1844 S 15TH ST, MILWAUKEE, WI 53204-3225
(414) 999-0999
(414) 562-6888
Mailing address
1844 S 15TH ST, MILWAUKEE, WI 53204-3225
(414) 999-0999
(414) 562-6888
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071374
—
WI
Enumeration date
11/10/2022
Last updated
11/10/2022
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