Organization
LIFEWAY HOLDINGS LLC
Active
Other names
LIFEWAY PHARMACY, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDMOND ISAAC NGAZAL (DIRECTOR/PHARMACIST I/C)
(443) 531-3107
Entity
Organization
Contact information
Practice address
700 MERRITT BLVD, SUITE 1A, DUNDALK, MD 21222
(443) 530-3731
(443) 530-3859
Mailing address
700 MERRITT BLVD, SUITE 1A, DUNDALK, MD 21222
(443) 530-3731
(443) 530-3859
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07159
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158496
PK
—
Enumeration date
03/02/2016
Last updated
08/11/2022
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