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NPI Code Detail

MEDICARE: DR. LAURIE SIDES LIVENGOOD PHARMD

MEDICARE: DR. LAURIE SIDES LIVENGOOD PHARMD
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
1183500000XPharmacist20189NC

General Provider Information

NPI Number : 1073800959
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURIE SIDES LIVENGOOD PHARMD
Provider Business Mailing Address
First Line : 1040 HANES MALL BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-1309
Country : US
Telephone Number : 336-774-9623
Fax Number : 336-774-9623
Provider Business Practice Location Address
First Line : 1040 HANES MALL BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-1309
Country : US
Telephone Number : 336-774-9623
Fax Number : 336-774-9623
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2011
Last Update Date : 06/29/2011

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Directions to “ DR. LAURIE SIDES LIVENGOOD PHARMD” Practice Location

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