MEDICARE: ARRIVA MEDICAL, 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	3336C0003X	Community/Retail Pharmacy	PH25607	FL
2	3336C0003X	Community/Retail Pharmacy	PH2.7239	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5706760	OTHER		NCPDP

General Provider Information

NPI Number	:	1932497013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARRIVA MEDICAL, LLC

Provider Business Mailing Address
First Line	:	4252 NW 120TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065
Country	:	US
Telephone Number	:	800-700-4442
Fax Number	:	615-815-3130

Provider Business Practice Location Address
First Line	:	4252 NW 120TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065
Country	:	US
Telephone Number	:	800-700-4442
Fax Number	:	877-223-0483

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM K STOCKSDALE
Credential	:
Telephone Number	:	954-864-2005

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	10/02/2015

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