Life Extension Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH22301 Issued in FL

Legal business name

LIFE EXTENSION PHARMACY INC

Doing business as

LIFE EXTENSION PHARMACY INC

Practice address

5990 N Federal Hwy
Fort Lauderdale, FL 33308-2633

Phone

(877) 877-9700

Fax

(877) 877-9708

NPI assigned

Nov 2, 2006

Organization subpart

No

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

Authorized official

Name

Melanie Kamburian, PHARMACIST

Title

Paralegal

Phone

(954) 202-7729

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• LIFE EXTENSION PHARMACY INC Doing business as

Locations

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1467530873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 W COMMERCIAL BLVD",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333093338",
            "telephone_number": "954-202-7729",
            "fax_number": "954-202-7729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5990 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333082633",
            "telephone_number": "877-877-9700",
            "fax_number": "877-877-9708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE EXTENSION PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "KAMBURIAN",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "PARALEGAL",
        "authorized_official_telephone_number": "954-202-7729",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH22301",
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2007736",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFE EXTENSION PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.