NPIMap

Organization Active NPI

Life Change RX LLC

Doing business as Life Change Pharmacy 1 Long term care

  • Long Term Care Pharmacy
  • Milwaukee, WI
National Provider Identifier
1205544913
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
LIFE CHANGE RX LLC
Doing business as
Life Change Pharmacy 1 Long term care
Practice address
1844 S 15TH St
Milwaukee, WI 53204-3225
Phone
(414) 999-0999
Fax
(414) 562-6888
NPI assigned
Nov 10, 2022
Last updated
Nov 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Authorized official

Name
Ali Ahmed Nafea Ali, R.PH
Title
Co-Owner
Phone
(414) 999-0999

Specialties & licenses 1

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

Addresses

Primary practice location

1844 S 15TH St
Milwaukee, WI 53204-3225

Mailing address

1844 S 15TH St
Milwaukee, WI 53204-3225
Phone (414) 999-0999

Other identifiers 1

IdentifierTypeStateIssuer
100071374MedicaidWI

Other names 1

  • Life Change Pharmacy 1 Long term care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Life Change Pharmacy 12 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.

NPI Registry JSON

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1205544913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1844 S 15TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043225",
            "telephone_number": "414-999-0999",
            "fax_number": "414-562-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1844 S 15TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043225",
            "telephone_number": "414-999-0999",
            "fax_number": "414-562-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHANGE RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "ALI",
        "authorized_official_middle_name": "AHMED NAFEA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "414-999-0999",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071374",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Change Pharmacy 1 Long term care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.