Healthcare Provider Details

I. General information

NPI: 1306945266
Provider Name (Legal Business Name): LIVELY DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LIVELY OAKS RD STATE RT 3
LIVELY VA
22507
US

IV. Provider business mailing address

PO BOX 399
LIVELY VA
22507-0399
US

V. Phone/Fax

Practice location:
  • Phone: 804-462-5644
  • Fax: 804-462-5667
Mailing address:
  • Phone:
  • Fax:

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 Number0201000427
License Number StateVA

VIII. Authorized Official

Name: THOAMS BEANE
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 804-462-5644