Organization
LIFESTREAM MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMITRIOS MELEKOS (PRESIDENT)
(215) 357-2303
Entity
Organization
Contact information
Practice address
55 BUCK RD STE 8, HUNTINGDON VALLEY, PA 19006-1501
(215) 357-2303
(215) 357-2305
Mailing address
55 BUCK RD STE 8, HUNTINGDON VALLEY, PA 19006-1501
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481392
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011142410001
—
PA
01
—
3983586
OTHER ID NUMBER
—
Enumeration date
06/18/2006
Last updated
07/20/2007
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