Provider Demographics
NPI:1811134869
Name:LIVEWELL INC
Entity type:Organization
Organization Name:LIVEWELL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-933-6337
Mailing Address - Street 1:521 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8071
Mailing Address - Country:US
Mailing Address - Phone:704-658-9870
Mailing Address - Fax:704-658-9871
Practice Address - Street 1:521 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8071
Practice Address - Country:US
Practice Address - Phone:704-658-9870
Practice Address - Fax:704-658-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3413274OtherNCPDP PROVIDER IDENTIFICATION NUMBER