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General NPI Number Information
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NPI Number | 1780970673
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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 | 06/20/2011
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 1555 PORT MALABAR BLVD NE STE 102B
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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 #102B
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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 | PHARMACY DEPT MANAGER
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Name | CARL ACQUAVIVA
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Credential |
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Telephone | 321-768-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH25270
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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