Provider Demographics
NPI:1972058535
Name:JENEV ENTERPRISES LLC
Entity Type:Organization
Organization Name:JENEV ENTERPRISES LLC
Other - Org Name:LIVEWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHARMACY MANAGER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:DHARMENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-220-8098
Mailing Address - Street 1:477 STATE ROUTE 10 UNIT 13
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2142
Mailing Address - Country:US
Mailing Address - Phone:973-775-9818
Mailing Address - Fax:973-775-9816
Practice Address - Street 1:477 STATE ROUTE 10 UNIT 13
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2142
Practice Address - Country:US
Practice Address - Phone:973-775-9818
Practice Address - Fax:973-775-9816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0004X, 3336L0003X, 3336S0011X
NJ28RS007540003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164175OtherPK