Provider Demographics
NPI:1174003552
Name:LIVE OAK PHARMACY,LLC
Entity Type:Organization
Organization Name:LIVE OAK PHARMACY,LLC
Other - Org Name:LIVE OAK PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU ATIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-532-1008
Mailing Address - Street 1:2105 W SPRING CREEK PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 W SPRING CREEK PKWY STE 325
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4552
Practice Address - Country:US
Practice Address - Phone:972-532-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32209333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy