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General NPI Number Information
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NPI Number | 1669713939
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Entity Type | Organization
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Legal Business Name | LIVINGSTON MANOR PHARMACY LLC
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 47 STEWART AVE
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City | ROSCOE
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State | NY
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Zip | 12776-5105
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Country | US
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Telephone | 607-498-4111
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Fax | 607-498-4113
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | ROSCOE
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State | NY
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Zip | 12776-0146
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Country | US
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Telephone | 607-498-4111
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Fax | 607-498-4113
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Authorized Official
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Title or Position | MEMBER
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Name | SHEETAL PATEL
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Credential |
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Telephone | 845-297-0549
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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 | 031823
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License Number State | NY
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