1225959968 NPI number — LIFEFILL I, LLC

Table of content: (NPI 1225959968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225959968 NPI number — LIFEFILL I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEFILL I, LLC
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:
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:
1225959968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 BROADWAY RM 1910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018-2874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12639 W EXPLORER DR STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83713-1887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-898-9368
Provider Business Practice Location Address Fax Number:
855-251-0222
Provider Enumeration Date:
07/21/2026

Additional Information

Authorized Official

Authorized Official Last Name:
NAMETH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CLOUD AND SPECIALTY PHARMACY
Authorized Official Telephone Number:
646-201-9585

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1781728 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com