Provider Demographics
NPI:1508161910
Name:LIVERNOIS RX, INC.
Entity Type:Organization
Organization Name:LIVERNOIS RX, INC.
Other - Org Name:IMPRIMISRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-930-5254
Mailing Address - Street 1:1105 CENTRAL EXPWY N.
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:469-656-7987
Mailing Address - Fax:469-421-2150
Practice Address - Street 1:1105 CENTRAL EXPWY N
Practice Address - Street 2:SUITE 2110
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:844-370-8581
Practice Address - Fax:469-675-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27324333600000X, 3336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27324OtherPHARMACY LICENSE
5902285OtherNCPDP
FC2423248OtherDEA