Provider Demographics
NPI:1851079107
Name:ACIVICS PHARMACY, INC.
Entity Type:Organization
Organization Name:ACIVICS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:ACHOLONU
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:352-316-5453
Mailing Address - Street 1:2441 NORTHWEST 43RD STREET
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-316-5453
Mailing Address - Fax:
Practice Address - Street 1:2441 NORTHWEST 43RD STREET
Practice Address - Street 2:SUITE 5C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-316-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy