Organization
AVIVA CARE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIROSIS GONZALEZ (OWNER)
(954) 451-5578
Entity
Organization
Contact information
Practice address
2053 N UNIVERSITY DR, SUNRISE, FL 33322-3936
(954) 451-5578
(954) 451-5208
Mailing address
2053 N UNIVERSITY DR, SUNRISE, FL 33322-3936
(954) 451-5578
(954) 451-5208
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29522
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016640900
—
FL
01
—
2155438
PK
—
Enumeration date
10/07/2015
Last updated
04/23/2020
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