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General NPI Number Information
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NPI Number | 1306945266
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Entity Type | Organization
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Legal Business Name | LIVELY DRUG COMPANY INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 36 LIVELY OAKS RD STATE RT 3
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City | LIVELY
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State | VA
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Zip | 22507
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Country | US
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Telephone | 804-462-5644
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Fax | 804-462-5667
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | LIVELY
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State | VA
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Zip | 22507-0399
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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 | OWNER PHARMACIST
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Name | THOAMS BEANE
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Credential | RPH
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Telephone | 804-462-5644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201000427
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License Number State | VA
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