Lifeway Holdings LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P07159 Issued in MD

Legal business name

LIFEWAY HOLDINGS LLC

Practice address

700 Merritt Blvd
Suite 1a
Dundalk, MD 21222

Phone

(443) 530-3731

Fax

(443) 530-3859

NPI assigned

Mar 2, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Edmond Isaac NgazalNPI 1811448392

Title

Director/Pharmacist I/C

Phone

(443) 531-3107

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• LIFEWAY PHARMACY, LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edmond Ngazal

  • Pharmacist
  • Baltimore, MD
  • NPI 1811448392
  NPD (past) Authorized official

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1215397385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 MERRITT BLVD",
            "address_2": "SUITE 1A",
            "city": "DUNDALK",
            "state": "MD",
            "postal_code": "21222",
            "telephone_number": "443-530-3731",
            "fax_number": "443-530-3859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MERRITT BLVD",
            "address_2": "SUITE 1A",
            "city": "DUNDALK",
            "state": "MD",
            "postal_code": "21222",
            "telephone_number": "443-530-3731",
            "fax_number": "443-530-3859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWAY HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "NGAZAL",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "ISAAC",
        "authorized_official_title_or_position": "DIRECTOR/PHARMACIST I/C",
        "authorized_official_telephone_number": "443-531-3107",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P07159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158496",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFEWAY PHARMACY, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIFEWAY PHARMACY, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aleasha Ann Lewis
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• Lifespan Rehab LLC.
• Rachael Lindo, LMSW
• Jennifer Anne Lisa, PMHNP-BC
• Danielle Lloyd, M.A., C.A.S., NCSP
• Sarice Lui, OD
• Kelly Michele Maher, LCPC

• Community/Retail Pharmacy in Dundalk, MD
• Providers in Dundalk, MD by specialty
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.