Organization Active NPI

Life Pharmacy Inc

  • Pharmacist
  • Brooklyn, NY
National Provider Identifier
1275673923
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
047043-1 Issued in NY
Legal business name
LIFE PHARMACY INC
Practice address
4301 14TH Ave
Brooklyn, NY 11219-1429
Phone
(718) 438-1421
Fax
(718) 438-1483
NPI assigned
Feb 8, 2007
Last updated
Jun 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

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

Authorized official

Name
Elan Gutman
Title
Pharmacist
Phone
(718) 438-1421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 047043-1 NY Primary

Addresses

Primary practice location

4301 14TH Ave
Brooklyn, NY 11219-1429

Mailing address

4301 14TH Ave
Brooklyn, NY 11219-1429
Phone (718) 438-1421

Other identifiers 1

IdentifierTypeStateIssuer
02473958MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240408001155 NY Part B Supplier - Mass Immunization (Roster Biller Only) 4284842519 Practice locations: Brooklyn, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Life Pharmacy Inc4301 14TH Ave, Brooklyn, NY 11219-1429(718) 438-1421 Nebulizer Drugs Does not accept assignmentParticipating since Mar 6, 2004

National Provider Directory

National Provider Directory

Locations

4301 14th Ave
Brooklyn, NY 11219
Phone (718) 438-1421

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749081600000",
    "number": "1275673923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 14TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112191429",
            "telephone_number": "718-438-1421",
            "fax_number": "718-438-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 14TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112191429",
            "telephone_number": "718-438-1421",
            "fax_number": "718-438-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A",
        "authorized_official_last_name": "GUTMAN",
        "authorized_official_first_name": "ELAN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "718-438-1421"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "047043-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02473958",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.