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General NPI Number Information
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NPI Number | 1679638753
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Entity Type | Organization
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Legal Business Name | MELVIN P LIVINGSTEN JR
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1189 JOHN SIMS PKWY
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-729-3684
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Fax | 850-729-0944
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Provider Business Mailing Address
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Address Line | 1189 JOHN SIMS PKWY
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-729-3684
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Fax | 850-729-0944
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Authorized Official
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Title or Position | RPH OWNER
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Name | MR. MELVIN P LIVINGSTEN JR.
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Credential | RPH
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Telephone | 850-729-3684
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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 | PH15121
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License Number State | FL
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