Organization
CARL D ACQUAVIVA
Active
Other names
Acquaviva's LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARL ACQUAVIVA (PHARMACY DEPT MANAGER)
(321) 768-1400
Entity
Organization
Contact information
Practice address
1555 PORT MALABAR BLVD NE STE 102B, PALM BAY, FL 32905-5407
(321) 725-7188
(321) 728-1333
Mailing address
1555 PORT MALABAR BLVD NE, SUITE #102B, PALM BAY, FL 32905-5407
(321) 725-7188
(321) 728-1333
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH25270
FL
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104293900
—
FL
01
—
2131033
PK
—
Enumeration date
06/20/2011
Last updated
02/05/2019
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