Organization
LIFELINE INFUSION SERVICES, INC.
Active
Other names
LIFELINE INFUSION SVCS INC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL MARTIN (SECRETARY/TREASURER)
(631) 472-2929
Entity
Organization
Contact information
Practice address
559 MIDDLE RD, BAYPORT, NY 11705-1931
(631) 472-2929
(631) 472-6882
Mailing address
559 MIDDLE RD, BAYPORT, NY 11705-1931
(631) 472-2929
(631) 472-6882
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
021626
NY
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420626
—
NY
01
—
2063801
PK
—
Enumeration date
07/12/2006
Last updated
08/15/2016
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