Healthcare Provider Details

I. General information

NPI: 1609921071
Provider Name (Legal Business Name): LIVE AND LET LIVE DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W ROCKWOOD ST
ROCKWOOD TN
37854-2243
US

IV. Provider business mailing address

225 W ROCKWOOD ST
ROCKWOOD TN
37854-2243
US

V. Phone/Fax

Practice location:
  • Phone: 865-354-0234
  • Fax: 865-354-2290
Mailing address:
  • Phone: 865-354-0234
  • Fax: 865-354-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000002041
License Number StateTN

VIII. Authorized Official

Name: SHERRY HILL
Title or Position: OWNER/PRESIDENT
Credential: DPH
Phone: 865-354-0234