MEDICARE: UNIVITA SPECIALTY INFUSION PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy	PH 24405	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053064	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1124354832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVITA SPECIALTY INFUSION PHARMACY LLC

Provider Business Mailing Address
First Line	:	11000 PRAIRIE LAKES DR
Second Line	:	SUITE 600
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3885
Country	:	US
Telephone Number	:	952-546-6800
Fax Number	:	952-983-5202

Provider Business Practice Location Address
First Line	:	3700 COMMERCE PKWY
Second Line	:	SUITE A
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3912
Country	:	US
Telephone Number	:	954-217-6055
Fax Number	:	954-217-6062

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	ARNOLD FINKEL
Credential	:
Telephone Number	:	954-217-6055

Provider Enumeration Date	:	10/30/2009
Last Update Date	:	06/21/2010

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