| NPI | 1366714974 |
|---|---|
| Doing Business As | LIFESOURCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL WONG President 718-803-8393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NY 031093) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-05-04 |