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Organization
LIVE OAKS OCTAGON
Active
Organization
LIVE OAKS OCTAGON
Active
Other names
Live Oaks Octagon, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TOM MULLEN (MANAGER)
(646) 729-7578
Entity
Organization
Contact information
Practice address
13521 STEELECROFT PKWY, CHARLOTTE, NC 28278-7551
(646) 729-7578
(980) 256-4715
Mailing address
13521 STEELECROFT PKWY, SUITE B, CHARLOTTE, NC 28278-7551
(646) 729-7578
(980) 256-4715
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160273
PK
—
Enumeration date
05/19/2016
Last updated
08/02/2016
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