Organization
LIVE OAK PHARMACY LLC
Active
Other names
Live Oak Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN POPE (OWNER, PIC)
(512) 476-8979
Entity
Organization
Contact information
Practice address
1611 W 5TH ST STE 160, AUSTIN, TX 78703-4874
(512) 476-8979
(512) 476-8980
Mailing address
1611 W 5TH ST, SUITE 160, AUSTIN, TX 78703-4874
(512) 476-8979
(512) 476-8980
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26887
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4555302
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/09/2010
Last updated
05/13/2010
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