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General NPI Number Information
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NPI Number | 1306307707
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Entity Type | Organization
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Legal Business Name | LIVE WELL PHARMACY INC
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 15871 POMONA RINCON RD STE 110
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City | CHINO HILLS
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State | CA
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Zip | 91709-5563
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Country | US
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Telephone | 909-325-2211
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Fax | 909-325-2141
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Provider Business Mailing Address
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Address Line | 15871 POMONA RINCON RD STE 110
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City | CHINO HILLS
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State | CA
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Zip | 91709-5563
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Country | US
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Telephone | 909-325-2211
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Fax | 909-325-2141
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | DR. JAKE W CHUANG
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Credential | PHARM D
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Telephone | 909-325-2211
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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 |
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License Number State |
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