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General NPI Number Information
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NPI Number | 1528203775
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Entity Type | Organization
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Legal Business Name | CARL D ACQUAVIVA
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 1555 PORT MALABAR BLVD NE SUITE 101
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City | PALM BAY
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State | FL
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Zip | 32905-5407
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Country | US
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Telephone | 321-725-7188
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Fax | 321-728-1333
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Provider Business Mailing Address
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Address Line | 1555 PORT MALABAR BLVD NE SUITE 101
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City | PALM BAY
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State | FL
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Zip | 32905-5407
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Country | US
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Telephone | 321-725-7188
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Fax | 321-728-1333
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | CARL D ACQUAVIVA
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Credential | RPH
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Telephone | 321-725-7188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH10316
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License Number State | FL
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