NPIMap

Organization Active NPI

Life Tree Pharmacy Services Incorporated

  • Long Term Care Pharmacy
  • Broussard, LA
National Provider Identifier
1124595558
Registry record updated Jul 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
LIFE TREE PHARMACY SERVICES INCORPORATED
Practice address
120 Park Center Drive
Broussard, LA 70518-3605
Phone
(610) 489-6640
Fax
(610) 489-6645
NPI assigned
Oct 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2019

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

Authorized official

Name
Mark Taglianetti
Title
Ceo
Phone
(610) 489-6640

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

120 Park Center Drive
Broussard, LA 70518-3605

Mailing address

5 Blue Heron Drive
Collegeville, PA 19426-2057
Phone (610) 489-6640

National Provider Directory

National Provider Directory
Tax ID family
Life Tree Pharmacy3 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.

Locations

120 Park Center Dr
Broussard, LA 70518
Phone (337) 252-7171

NPI Registry JSON

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1124595558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BLUE HERON DRIVE",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194262057",
            "telephone_number": "610-489-6640",
            "fax_number": "610-489-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PARK CENTER DRIVE",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705183605",
            "telephone_number": "610-489-6640",
            "fax_number": "610-489-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE TREE PHARMACY SERVICES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "TAGLIANETTI",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "610-489-6640"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broussard, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; 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.