MEDICARE: UNIVV 3 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1760171581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVV 3 INC

Provider Business Mailing Address
First Line	:	11918 BAY OAK DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-9376
Country	:	US
Telephone Number	:	201-344-6411
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 NICHOLAS PKWY NW STE 6
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3804
Country	:	US
Telephone Number	:	201-344-6411
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ PHARMACY MANAGER
Name	:	HEMAL DESAI
Credential	:
Telephone Number	:	201-344-6411

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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