| NPI | 1821316647 |
|---|---|
| Doing Business As | LIFE SOURCE PHARMACY, INC |
| Entity Type | Organization |
| Authorized Contact | PRASHANT PATEL President 773-321-2656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054-017353) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2015-03-22 |