Organization
TEXAS LIVER CONSULTANTS INC
Active
Other names
Liv-Well Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMIE MISKIMINS (MANAGER)
(817) 572-0009
Entity
Organization
Contact information
Practice address
607 CAMDEN ST STE 102, SAN ANTONIO, TX 78215-2100
(210) 390-0091
Mailing address
1620 W. NORTHWEST HWY, STE. 100, GRAPEVINE, TX 76051
(817) 572-0009
(817) 720-1039
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
29635
TX
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148970
PK
—
Enumeration date
11/24/2014
Last updated
06/30/2016
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