=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932497013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARRIVA MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2011
-----------------------------------------------------
Last Update Date | 10/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4252 NW 120TH AVE
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-700-4442
-----------------------------------------------------
Fax | 877-223-0483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4252 NW 120TH AVE
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-700-4442
-----------------------------------------------------
Fax | 615-815-3130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM K STOCKSDALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-864-2005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH25607
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH2.7239
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------