Provider Demographics
NPI:1306307707
Name:LIVE WELL PHARMACY INC
Entity type:Organization
Organization Name:LIVE WELL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHUANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-325-2211
Mailing Address - Street 1:15871 POMONA RINCON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5563
Mailing Address - Country:US
Mailing Address - Phone:909-325-2211
Mailing Address - Fax:909-325-2141
Practice Address - Street 1:15871 POMONA RINCON RD STE 110
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5563
Practice Address - Country:US
Practice Address - Phone:909-325-2211
Practice Address - Fax:909-325-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy