MEDICARE: VIVA PHARMACY & WELLNESS

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	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	033886	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2154031	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659748150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVA PHARMACY & WELLNESS

Provider Business Mailing Address
First Line	:	8014 NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1345
Country	:	US
Telephone Number	:	718-450-9595
Fax Number	:	718-450-9797

Provider Business Practice Location Address
First Line	:	8014 NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1345
Country	:	US
Telephone Number	:	718-450-9595
Fax Number	:	718-450-9797

Authorized Official
Title or Position	:	PIC, AO
Name	:	LATCHMIN RAGHUNAUTH
Credential	:	DOCTOR OF PHARM
Telephone Number	:	718-450-9696

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	10/31/2024

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Directions to “VIVA PHARMACY & WELLNESS ” Practice Location

Language	Start Address	Practice Location

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