Organization
CARL D ACQUAVIVA
Active
Organization
CARL D ACQUAVIVA
Active
Other names
ACQUAVIVA'S PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CARL D ACQUAVIVA RPH (OWNER PHARMACIST)
(321) 725-7188
Entity
Organization
Contact information
Practice address
1555 PORT MALABAR BLVD NE, UNIT 101, PALM BAY, FL 32905-5407
(321) 725-7188
(321) 728-1333
Mailing address
1555 PORT MALABAR BLVD NE, UNIT 101, PALM BAY, FL 32905-5407
(321) 725-7188
(321) 728-1333
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH10316
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1038036
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
104293900
—
FL
05
—
104293901
—
FL
Enumeration date
08/10/2006
Last updated
04/02/2009
Update your record
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