Organization
SHIVOAM LLC
Active
Other names
MEDICINE SHOPPE DELAND, Angel's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HARDIK G SHAH (OWNER)
(352) 272-5944
Entity
Organization
Contact information
Practice address
319 S WOODLAND BLVD, DELAND, FL 32720
(386) 734-3383
(386) 734-3384
Mailing address
319 S WOODLAND BLVD, DELAND, FL 32720
(386) 734-3383
(386) 734-3384
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PH11083
FL
3336C0003X
Community/Retail Pharmacy
Primary
PH11083
FL
3336C0004X
Compounding Pharmacy
PH11083
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1064512
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
109020800
—
FL
Enumeration date
02/21/2006
Last updated
03/07/2023
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