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General NPI Number Information
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NPI Number | 1407172901
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Entity Type | Organization
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Legal Business Name | LIVE OAK PHARMACY LLC
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 1611 W 5TH ST STE 160
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City | AUSTIN
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State | TX
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Zip | 78703-4874
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Country | US
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Telephone | 512-476-8979
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Fax | 512-476-8980
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Provider Business Mailing Address
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Address Line | 1611 W 5TH ST SUITE 160
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City | AUSTIN
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State | TX
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Zip | 78703-4874
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Country | US
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Telephone | 512-476-8979
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Fax | 512-476-8980
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Authorized Official
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Title or Position | OWNER, PIC
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Name | NATHAN POPE
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Credential |
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Telephone | 512-476-8979
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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 | 26887
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License Number State | TX
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