Life Change RX 1 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LIFE CHANGE RX 1 LLC

Practice address

7115 W Capitol Dr
Milwaukee, WI 53216-2051

Phone

(414) 600-2000

Fax

(414) 600-0414

NPI assigned

Apr 29, 2019

Organization subpart

No

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

Authorized official

Name

Ali A AliNPI 1124456140

Title

C-Owner

Phone

(414) 600-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Life Change Pharmacy 2 Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

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

• Ali Ahmed Nafea Ali, R.PH

  • Pharmacist
  • Milwaukee, WI
  • NPI 1124456140
  NPD Authorized official
• Mohamed El Sheikh, PHARMACIST

  • Pharmacist
  • Milwaukee, WI
  • NPI 1467739748
  NPD

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1952965576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1844 S 15TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043225",
            "telephone_number": "414-600-2000",
            "fax_number": "414-600-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7115 W CAPITOL DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532162051",
            "telephone_number": "414-600-2000",
            "fax_number": "414-600-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHANGE RX 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "ALI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "C-OWNER",
        "authorized_official_telephone_number": "414-600-2000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071374",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Change Pharmacy 2",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Change Pharmacy 2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elisabeth Lien
• Jared M Lieungh, PAC
• Amanda Liewen, M.D.
• Life Adult Family Home LLC
• Life and Liberty Home Healthcare, LLC
• Life Change RX 3 LLC
• Life Change RX 4 LLC
• Life Change RX LLC
• Life Change RX LLC
• Life Change RX LLC

• All providers in Milwaukee, WI
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.