Provider Demographics
NPI:1609921071
Name:LIVE AND LET LIVE DRUG STORE, INC
Entity Type:Organization
Organization Name:LIVE AND LET LIVE DRUG STORE, INC
Other - Org Name:LIVE AND LET LIVE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:865-354-0234
Mailing Address - Street 1:225 W ROCKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-2243
Mailing Address - Country:US
Mailing Address - Phone:865-354-0234
Mailing Address - Fax:865-354-2290
Practice Address - Street 1:225 W ROCKWOOD ST
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-2243
Practice Address - Country:US
Practice Address - Phone:865-354-0234
Practice Address - Fax:865-354-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000020413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3546051Medicaid
2095996OtherPK
0882240001Medicare NSC
TN0882240001Medicare NSC