=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073746608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSAL ARTS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2009
-----------------------------------------------------
Last Update Date | 05/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14350 NW 56TH CT UNIT 114
-----------------------------------------------------
City | OPA LOCKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33054-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-2673
-----------------------------------------------------
Fax | 305-556-9749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14350 NW 56TH CT UNIT 114
-----------------------------------------------------
City | OPA LOCKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33054-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-2673
-----------------------------------------------------
Fax | 305-556-9749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RPH/CEO
-----------------------------------------------------
Name | RAMON SEVERINO MORENO
-----------------------------------------------------
Credential | BS PHARM.
-----------------------------------------------------
Telephone | 305-556-2673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | PH0013996
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------