Provider Demographics
NPI:1467830786
Name:LIVE WELL RX LLC
Entity Type:Organization
Organization Name:LIVE WELL RX LLC
Other - Org Name:LIVE WELL PHARMACY AT CHURCH LN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-466-2359
Mailing Address - Street 1:3811 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3113
Mailing Address - Country:US
Mailing Address - Phone:610-626-4549
Mailing Address - Fax:
Practice Address - Street 1:727 CHURCH LN
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3502
Practice Address - Country:US
Practice Address - Phone:484-466-2359
Practice Address - Fax:484-466-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4825503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151831OtherPK