Provider Demographics
NPI:1861147571
Name:LIVINGSTON, GRANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
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 1:2402 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-8998
Mailing Address - Country:US
Mailing Address - Phone:217-825-5505
Mailing Address - Fax:
Practice Address - Street 1:305 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1758
Practice Address - Country:US
Practice Address - Phone:812-948-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022456183500000X
IN26029533A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist