Organization
JENEV ENTERPRISES LLC
Active
Other names
LiveWell Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DHARMENDRA PATEL RPH (CEO/PHARMACY MANAGER/PIC/AO)
(973) 220-8098
Entity
Organization
Contact information
Practice address
477 STATE ROUTE 10 UNIT 13, RANDOLPH, NJ 07869-2142
(973) 775-9818
(973) 775-9816
Mailing address
477 STATE ROUTE 10 UNIT 13, RANDOLPH, NJ 07869-2142
(973) 775-9818
(973) 775-9816
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00754000
NJ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164175
PK
—
Enumeration date
08/23/2016
Last updated
03/06/2017
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