Provider Demographics
NPI:1164141115
Name:LIVINGSTON, JUSTIN RYAN (PHARMD MS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RYAN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PHARMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4245
Mailing Address - Country:US
Mailing Address - Phone:801-714-4150
Mailing Address - Fax:801-714-4102
Practice Address - Street 1:870 E 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4245
Practice Address - Country:US
Practice Address - Phone:801-714-4150
Practice Address - Fax:801-714-4102
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8338187-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist