Organization
LIFE LINE HOME CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONNIE C DANIEL PHARMD (PRESIDENT)
(229) 382-1334
Entity
Organization
Contact information
Practice address
1610 MADISON AVE, TIFTON, GA 31794-3756
(229) 382-1334
(229) 382-1350
Mailing address
1610 MADISON AVE, TIFTON, GA 31794-3756
(229) 382-1334
(229) 382-1350
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1370
FL
332B00000X
Durable Medical Equipment & Medical Supplies
PHRE007390
GA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
1370
FL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHRE007390
GA
332BX2000X
Oxygen Equipment & Supplies (DME)
322562
FL
332BX2000X
Oxygen Equipment & Supplies (DME)
PHRE007390
GA
333600000X
Pharmacy
PH18569
FL
333600000X
Pharmacy
Primary
PHRE007390
GA
3336C0004X
Compounding Pharmacy
PH18569
FL
3336C0004X
Compounding Pharmacy
PHRE007390
GA
3336H0001X
Home Infusion Therapy Pharmacy
PH18569
FL
3336H0001X
Home Infusion Therapy Pharmacy
PHRE007390
GA
3336S0011X
Specialty Pharmacy
PH18569
FL
3336S0011X
Specialty Pharmacy
PHRE007390
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00494337A
—
GA
05
—
00494337B
—
GA
01
—
1148243
NABP
GA
Enumeration date
01/10/2012
Last updated
01/10/2012
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