Provider Demographics
NPI:1235653577
Name:VIVA PHARMACY LLC
Entity Type:Organization
Organization Name:VIVA PHARMACY LLC
Other - Org Name:VIVA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:VIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARMACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-985-1816
Mailing Address - Street 1:114 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3293
Mailing Address - Country:US
Mailing Address - Phone:407-985-1816
Mailing Address - Fax:407-745-4536
Practice Address - Street 1:114 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3293
Practice Address - Country:US
Practice Address - Phone:407-985-1816
Practice Address - Fax:407-745-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH30802333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170059OtherPK