Provider Demographics
NPI:1477603082
Name:LIVOLSI, JOSEPH F (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:LIVOLSI
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 1:105 WINDING BROOK FARM RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1743
Mailing Address - Country:US
Mailing Address - Phone:860-274-1987
Mailing Address - Fax:
Practice Address - Street 1:792 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-4117
Practice Address - Country:US
Practice Address - Phone:203-754-0181
Practice Address - Fax:203-596-8144
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist