| Doctor Name: | DR. EDITH UCHE LIVINUS |
| NPI Number: | 1083050181 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RPH022522 |
| Business Practice Address: | 773 Highway 138 Sw Suite 13 Riverdale, GA - 302961599 |
| Business Phone Number: | 7704619015 |
| Business Fax Number: | |
| Mailing Address: | 160 Moss Creek Walk, FAYETTEVILLE |
| State: | GA |
| Postal Code: | 302142692 |
| Phone Number: | 4042462166 |
| Fax Number: | |
| NPI Enumeration Date: | 05/15/2013 |
| NPI Last Update Date: | 05/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | RPH022522 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |