Lifestream Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481543 Issued in PA

Legal business name

LIFESTREAM PHARMACY INC

Doing business as

LIFESTREAM PHARMACY

Practice address

847 Easton Rd
Warrington, PA 18976-2906

Phone

(215) 491-0999

Fax

(215) 491-0977

NPI assigned

Jul 12, 2006

Organization subpart

No

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

Authorized official

Name

Demetrios Melekos, PHARMACY

Title

Owner/Phcy MGR

Phone

(215) 491-0999

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• LIFESTREAM PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Lifesream RX2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lifestream Pharmacy Inc

  • Long Term Care Pharmacy
  • Warrington, PA
  • NPI 1730308826
  NPD tax ID

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490313600000",
    "number": "1144255357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 EASTON RD",
            "city": "WARRINGTON",
            "state": "PA",
            "postal_code": "189762906",
            "telephone_number": "215-491-0999",
            "fax_number": "215-491-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "847 EASTON RD",
            "city": "WARRINGTON",
            "state": "PA",
            "postal_code": "189762906",
            "telephone_number": "215-491-0999",
            "fax_number": "215-491-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2017-03-24",
        "status": "A",
        "authorized_official_last_name": "MELEKOS",
        "authorized_official_first_name": "DEMETRIOS",
        "authorized_official_title_or_position": "OWNER/PHCY MGR",
        "authorized_official_telephone_number": "215-491-0999",
        "authorized_official_credential": "PHARMACY"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481543",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015654020001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2087685",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFESTREAM PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Warrington, PA
• Providers in Warrington, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.