=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124354832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVITA SPECIALTY INFUSION PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2009
-----------------------------------------------------
Last Update Date | 06/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 COMMERCE PKWY SUITE A
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-217-6055
-----------------------------------------------------
Fax | 954-217-6062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11000 PRAIRIE LAKES DR SUITE 600
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-546-6800
-----------------------------------------------------
Fax | 952-983-5202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | ARNOLD FINKEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-217-6055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | PH 24405
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------