Life Star Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LIFE STAR PHARMACY INC.

Practice address

1215 Jerome Ave
Bronx, NY 10452-3301

Phone

(718) 684-5010

Fax

(646) 217-3682

NPI assigned

Nov 16, 2017

Organization subpart

No

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

Authorized official

Name

Jose Solano

Title

President

Phone

(718) 684-5010

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1336652015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 JEROME AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104523301",
            "telephone_number": "718-684-5010",
            "fax_number": "718-684-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 JEROME AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104523301",
            "telephone_number": "718-684-5010",
            "fax_number": "646-217-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE STAR PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-16",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "SOLANO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-684-5010"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05737628",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rita Liegner, LMHC
• Kangmei Lievano, DO
• Sheila Keane Liewehr, M.D.
• Life Dome Adult Services
• Life Infusions Corp
• Lifespire, Inc.
• Lifespire, Inc.
• Lifestyle Solutions, Inc.
• Jill Light
• Jason M Lightbody, PA-C

• Community/Retail Pharmacy in Bronx, NY
• Providers in Bronx, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.