Provider Demographics
NPI:1225405608
Name:LIVINGSTON, BRADLEY GLENN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:GLENN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 AARON ARONOV DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1831
Mailing Address - Country:US
Mailing Address - Phone:205-923-4788
Mailing Address - Fax:
Practice Address - Street 1:7201 AARON ARONOV DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1831
Practice Address - Country:US
Practice Address - Phone:205-923-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist