Healthcare Provider Details

I. General information

NPI: 1235653577
Provider Name (Legal Business Name): VIVA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S SEMORAN BLVD
ORLANDO FL
32807-3293
US

IV. Provider business mailing address

114 S SEMORAN BLVD
ORLANDO FL
32807-3293
US

V. Phone/Fax

Practice location:
  • Phone: 407-985-1816
  • Fax: 407-745-4536
Mailing address:
  • Phone: 407-985-1816
  • Fax: 407-745-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30802
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIVA PHARMACY
Title or Position: RPH
Credential:
Phone: 407-985-1816