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General NPI Number Information
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NPI Number | 1558468488
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Entity Type | Organization
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Legal Business Name | LIVEWELL INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 4501 CAMERON VALLEY PKWY STE 125
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City | CHARLOTTE
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State | NC
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Zip | 28211-4299
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Country | US
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Telephone | 704-367-7440
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Fax | 704-365-2345
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Provider Business Mailing Address
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Address Line | 4501 CAMERON VALLEY PKWY STE 125 SUITE 125
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City | CHARLOTTE
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State | NC
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Zip | 28211-4299
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Country | US
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Telephone | 704-367-7440
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Fax | 704-365-2345
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Authorized Official
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Title or Position | PHARMACIST MANAGER OWNER
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Name | KRISTEN DINAN
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Credential | RPH
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Telephone | 704-367-7440
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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 | 7883
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License Number State | NC
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