Provider Demographics
NPI:1841597804
Name:LIVEYEV, OLEG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:LIVEYEV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10534 62ND DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1136
Mailing Address - Country:US
Mailing Address - Phone:718-275-6725
Mailing Address - Fax:
Practice Address - Street 1:10111 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4863
Practice Address - Country:US
Practice Address - Phone:718-779-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist