MEDICARE: ARRIVA MEDICAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PH 27239	FL

General Provider Information

NPI Number	:	1730501396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARRIVA MEDICAL, LLC

Provider Business Mailing Address
First Line	:	4252 NW 120TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-7603
Country	:	US
Telephone Number	:	800-700-4442
Fax Number	:	954-400-5423

Provider Business Practice Location Address
First Line	:	500 EAGLES LANDING DR
Second Line	:	SUITE B
City	:	LAKELAND
State	:	FL
Zip	:	33810-2899
Country	:	US
Telephone Number	:	866-336-4103
Fax Number	:	954-400-5423

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM STOCKSDALE
Credential	:
Telephone Number	:	954-864-2005

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/15/2014

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