Provider Demographics
NPI:1265029698
Name:LIVINGSTON, RICHARD B (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 WIND HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6163
Mailing Address - Country:US
Mailing Address - Phone:217-638-6745
Mailing Address - Fax:
Practice Address - Street 1:436 N 30TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3602
Practice Address - Country:US
Practice Address - Phone:217-224-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0159953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy