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General NPI Number Information
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NPI Number | 1225378771
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Entity Type | Organization
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Legal Business Name | LIVE GOOD PHARMACY INC
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 1025 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-3508
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Country | US
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Telephone | 718-221-9300
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Fax | 718-221-9302
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Provider Business Mailing Address
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Address Line | PO BOX 250018
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City | BROOKLYN
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State | NY
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Zip | 11225-0018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | DR. NGOZI AGBASIONWE
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Credential |
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Telephone | 718-221-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 031732
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License Number State | NY
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