MEDICARE: UNIVV I INC

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	3336C0003X	Community/Retail Pharmacy	PH29944	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159368	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548623028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVV I INC

Provider Business Mailing Address
First Line	:	4857 PALM BEACH BLVD
Second Line	:	UNIT-1
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3206
Country	:	US
Telephone Number	:	239-208-8847
Fax Number	:	239-208-8852

Provider Business Practice Location Address
First Line	:	4857 PALM BEACH BLVD STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3206
Country	:	US
Telephone Number	:	239-208-8847
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	ANIL HARKHANI
Credential	:
Telephone Number	:	239-208-8847

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	05/26/2016

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