Provider Demographics
NPI:1386090793
Name:GOOD LIVING INC
Entity type:Organization
Organization Name:GOOD LIVING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-404-4153
Mailing Address - Street 1:1201 N JIM DAY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-7219
Mailing Address - Country:US
Mailing Address - Phone:812-404-4153
Mailing Address - Fax:812-404-4160
Practice Address - Street 1:1201 N JIM DAY RD STE B
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-7219
Practice Address - Country:US
Practice Address - Phone:812-404-4153
Practice Address - Fax:812-404-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006567A333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159876OtherPK