Organization
LIFE SPECIALTY PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAJI DANIEL (DIRECTOR)
(972) 681-5959
Entity
Organization
Contact information
Practice address
949 W. KEARNEY ST., SUITE 107, MESQUITE, TX 75149
(972) 681-5959
Mailing address
18770 LBJ FWY STE 200, MESQUITE, TX 75150-6407
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150116
—
TX
Enumeration date
03/21/2019
Last updated
01/24/2020
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