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General NPI Number Information
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NPI Number | 1396852935
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Entity Type | Organization
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Legal Business Name | LIVING WELL PHARMACY #2 INC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 824 GI MADDOX PKWY SUITE B
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City | CHATSWORTH
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State | GA
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Zip | 30705-2073
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Country | US
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Telephone | 706-517-1901
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Fax | 706-517-2541
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Provider Business Mailing Address
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Address Line | 630 TI PI LN
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City | CHATSWORTH
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State | GA
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Zip | 30705-7786
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Country | US
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Telephone | 706-517-1901
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Fax | 706-517-2541
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Authorized Official
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Title or Position | CFO
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Name | PAUL PHILLIP BRYANT
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Credential |
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Telephone | 706-422-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHRE008958
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License Number State | GA
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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 |
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License Number State |
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