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NPI Code Detail

MEDICARE: LIVEWELL INC

MEDICARE: LIVEWELL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy10527NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13401863OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1043350556
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVEWELL INC
Provider Business Mailing Address
First Line : 2334 SOUTH BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5008
Country : US
Telephone Number : 704-523-8608
Fax Number : 704-523-8619
Provider Business Practice Location Address
First Line : 2334 SOUTH BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5008
Country : US
Telephone Number : 704-523-8608
Fax Number : 704-523-8619
Authorized Official
Title or Position : PRESIDENT PIC
Name : BRIAN FREEMAN
Credential :
Telephone Number : 704-933-6337
Provider Enumeration Date : 02/07/2007
Last Update Date : 01/23/2013

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Directions to “LIVEWELL INC ” Practice Location

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