1124354832 NPI number — UNIVITA SPECIALTY INFUSION PHARMACY LLC

Table of content: (NPI 1124354832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124354832 NPI number — UNIVITA SPECIALTY INFUSION PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVITA SPECIALTY INFUSION PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124354832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11000 PRAIRIE LAKES DR
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-3885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-546-6800
Provider Business Mailing Address Fax Number:
952-983-5202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 COMMERCE PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-217-6055
Provider Business Practice Location Address Fax Number:
954-217-6062
Provider Enumeration Date:
10/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FINKEL
Authorized Official First Name:
ARNOLD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
954-217-6055

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PH 24405 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053064 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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