Provider Demographics
NPI:1144712779
Name:LIVINGSTON, CLINT ALLAN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:CLINT
Middle Name:ALLAN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 PISANO ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-1542
Mailing Address - Country:US
Mailing Address - Phone:615-975-0602
Mailing Address - Fax:
Practice Address - Street 1:570 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4409
Practice Address - Country:US
Practice Address - Phone:615-355-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist