Lifestream Medical

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481392 Issued in PA

Legal business name

LIFESTREAM MEDICAL

Practice address

55 Buck Rd Ste 8
Huntingdon Valley, PA 19006-1501

Phone

(215) 357-2303

Fax

(215) 357-2305

NPI assigned

Jun 18, 2006

Organization subpart

No

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

Authorized official

Name

Demitrios Melekos

Title

President

Phone

(215) 357-2303

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1710922240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 BUCK RD STE 8",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190061501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 BUCK RD STE 8",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190061501",
            "telephone_number": "215-357-2303",
            "fax_number": "215-357-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "MELEKOS",
        "authorized_official_first_name": "DEMITRIOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-357-2303"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3983586",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3983586",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011142410001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Huntingdon Valley, PA
• Providers in Huntingdon Valley, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.