Provider Demographics
NPI:1275806796
Name:LIVINGSTON, RYAN L (CPHT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 SUMMER ST
Mailing Address - Street 2:CARRIAGE HOUSE
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1580
Mailing Address - Country:US
Mailing Address - Phone:305-905-8101
Mailing Address - Fax:
Practice Address - Street 1:54 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3359
Practice Address - Country:US
Practice Address - Phone:978-921-0506
Practice Address - Fax:978-921-0129
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH86537183700000X
MAPT8780183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician