1982294898 NPI number — LIFECHEK CARRIZO LLC NITRILIS RX #2

Table of content: (NPI 1982294898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982294898 NPI number — LIFECHEK CARRIZO LLC NITRILIS RX #2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECHEK CARRIZO LLC NITRILIS RX #2
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982294898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77406-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-928-9369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17215 RED OAK DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-602-3487
Provider Business Practice Location Address Fax Number:
281-407-2056
Provider Enumeration Date:
01/25/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ROYKO
Authorized Official First Name:
KARLI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
832-527-1416

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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