Provider Demographics
NPI:1558916502
Name:LIVE WELL PHARMACY LLC
Entity Type:Organization
Organization Name:LIVE WELL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:CHINTAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-781-2454
Mailing Address - Street 1:4200 STUART ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5759
Mailing Address - Country:US
Mailing Address - Phone:903-259-6797
Mailing Address - Fax:903-259-6689
Practice Address - Street 1:4200 STUART ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5759
Practice Address - Country:US
Practice Address - Phone:903-259-6797
Practice Address - Fax:903-259-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32700OtherTEXAS STATE BOARD OF PHARMACY