Provider Demographics
NPI:1053426254
Name:LIFECHEK CONROE PARTNERS LTD
Entity type:Organization
Organization Name:LIFECHEK CONROE PARTNERS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRAINING AND DVLPMNT SPECIALST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-646-5119
Mailing Address - Street 1:1316 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-3531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 GULFWAY DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2829
Practice Address - Country:US
Practice Address - Phone:409-982-9977
Practice Address - Fax:409-982-2318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX237663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4581383OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX466107Medicaid
4581383OtherNCPDP PROVIDER IDENTIFICATION NUMBER