Provider Demographics
NPI:1659821437
Name:ARRIVA MEDICAL, LLC
Entity Type:Organization
Organization Name:ARRIVA MEDICAL, LLC
Other - Org Name:ARRIVA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS VP
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-700-4442
Mailing Address - Street 1:310 EAGLES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2999
Mailing Address - Country:US
Mailing Address - Phone:866-336-4103
Mailing Address - Fax:877-223-0483
Practice Address - Street 1:310 EAGLES LANDING DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2999
Practice Address - Country:US
Practice Address - Phone:866-336-4103
Practice Address - Fax:877-223-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH272393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164270OtherPK