Organization
LIFE CHANGE RX 4 LLC
Active
Other names
Life Change Pharmacy 4
Organization subpart
No
Provider details
NPI number
Authorized official
ALI A ALI R.PH (PHARMACIST / OWNER)
(414) 999-0999
Entity
Organization
Contact information
Practice address
6300 N 76TH ST STE 246, MILWAUKEE, WI 53218-1208
(414) 999-0999
Mailing address
1844 S 15TH ST, MILWAUKEE, WI 53204-3225
(414) 999-0999
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
961842
WI STATE BOARD OF PHARMACY
WI
Enumeration date
11/15/2019
Last updated
11/15/2019
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