Provider Demographics
NPI:1013518356
Name:LIVINGSTON, JON (RPH)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-8998
Mailing Address - Country:US
Mailing Address - Phone:217-820-5025
Mailing Address - Fax:
Practice Address - Street 1:1530 W SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2756
Practice Address - Country:US
Practice Address - Phone:217-287-1121
Practice Address - Fax:217-287-1114
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist