Provider Demographics
NPI:1467188904
Name:LIVINGSTON, OLIVIA HALLE GRACE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:HALLE GRACE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:HALLE GRACE
Other - Last Name:PAULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1968
Mailing Address - Country:US
Mailing Address - Phone:731-926-1195
Mailing Address - Fax:
Practice Address - Street 1:800 WAYNE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1968
Practice Address - Country:US
Practice Address - Phone:731-926-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist