Organization
LIFE EXTENSION PHARMACY INC
Active
Other names
LIFE EXTENSION PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE KAMBURIAN PHARMACIST (PARALEGAL)
(954) 202-7729
Entity
Organization
Contact information
Practice address
5990 N FEDERAL HWY, FORT LAUDERDALE, FL 33308-2633
(877) 877-9700
(877) 877-9708
Mailing address
3600 W COMMERCIAL BLVD, FORT LAUDERDALE, FL 33309-3338
(954) 202-7729
(954) 202-7729
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22301
FL
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007736
PK
—
Enumeration date
11/02/2006
Last updated
03/04/2015
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