Provider Demographics
NPI:1679035315
Name:MYLYFE LLC
Entity type:Organization
Organization Name:MYLYFE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-314-6098
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083-0725
Mailing Address - Country:US
Mailing Address - Phone:844-469-5933
Mailing Address - Fax:
Practice Address - Street 1:31 MOODY RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3101
Practice Address - Country:US
Practice Address - Phone:844-469-5933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1679035315Medicaid