Provider Demographics
NPI:1245752013
Name:VIVA PHARMACY LLC
Entity Type:Organization
Organization Name:VIVA PHARMACY LLC
Other - Org Name:VIVA PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:YOUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORKOS
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:2017-07-12
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH308023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170059OtherPK