Organization
LIFE TREE PHARMACY SERVICES INCORPORATED
Active
Other names
Life Tree Pharmacy Services Incorporated
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TAGLIANETTI (PRESIDENT)
(610) 489-6640
Entity
Organization
Contact information
Practice address
5 BLUE HERON DR, COLLEGEVILLE, PA 19426-2057
(610) 489-6640
(610) 489-6645
Mailing address
5 BLUE HERON DR, COLLEGEVILLE, PA 19426-2057
(610) 489-6640
(610) 489-6645
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PP481454
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013015200001
—
PA
01
—
2085292
PK
—
Enumeration date
06/20/2006
Last updated
07/17/2019
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