Healthcare Provider Details

I. General information

NPI: 1861908972
Provider Name (Legal Business Name): VIVA CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 14 KM 18.3 SECTOR TIJERAS
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

1034 CALLE CERRO SALIENTE QUINTAS DE ALTAMIRA
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-987-8482
  • Fax: 787-987-8483
Mailing address:
  • Phone: 787-318-6966
  • Fax: 787-987-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number19-F-3528
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHANN NEGRON
Title or Position: CHIEF PHARMACIST
Credential: PHARM D
Phone: 787-318-6966