NPIMap

Organization Active NPI

Life Specialty Pharmacy, Inc

  • Compounding Pharmacy
  • Orlando, FL
National Provider Identifier
1063650612
Registry record updated Apr 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
PH23699 Issued in FL
Legal business name
LIFE SPECIALTY PHARMACY, INC
Doing business as
Life Specialty Pharmacy, Inc
Practice address
1507 Park Center Dr
Suite 1L
Orlando, FL 32835-5795
Phone
(407) 522-5683
Fax
(407) 522-5684
NPI assigned
Feb 4, 2009
Last updated
Apr 29, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Ayotunde
Title
Pharmacist
Phone
(407) 522-5683

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X PH23699 FL Primary
Home Infusion Therapy Pharmacy 3336H0001X
Long Term Care Pharmacy 3336L0003X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

1507 Park Center Dr
Suite 1L
Orlando, FL 32835-5795

Mailing address

1507 Park Center Dr
Suite 1L
Orlando, FL 32835-5795

Other identifiers 1

IdentifierTypeStateIssuer
1042009OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Life Specialty Pharmacy, Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Life Worth Living Foundation Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240963200000",
    "number": "1063650612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 PARK CENTER DR",
            "address_2": "SUITE 1L",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 PARK CENTER DR",
            "address_2": "SUITE 1L",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355795",
            "telephone_number": "407-522-5683",
            "fax_number": "407-522-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SPECIALTY PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-04",
        "last_updated": "2009-04-29",
        "status": "A",
        "authorized_official_last_name": "AYOTUNDE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "407-522-5683"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "FL",
            "license": "PH23699",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1042009",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Specialty Pharmacy, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.