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NPI Code Detail

MEDICARE: LIVE WELL PHARMACY INC

MEDICARE: LIVE WELL PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy5301010026MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12138523OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043569338
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVE WELL PHARMACY INC
Provider Business Mailing Address
First Line : 23411 JOHN R RD
Second Line :
City : HAZEL PARK
State : MI
Zip : 48030-1404
Country : US
Telephone Number : 248-381-4000
Fax Number : 248-381-4046
Provider Business Practice Location Address
First Line : 23411 JOHN R RD
Second Line :
City : HAZEL PARK
State : MI
Zip : 48030-1404
Country : US
Telephone Number : 248-381-4000
Fax Number : 248-381-4046
Authorized Official
Title or Position : PRESIDENT
Name : NOORA MERAM
Credential : B.SC. PHARMACY
Telephone Number : 248-381-4000
Provider Enumeration Date : 09/03/2012
Last Update Date : 03/01/2017

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Directions to “LIVE WELL PHARMACY INC ” Practice Location

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