Carl D Acquaviva

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

CARL D ACQUAVIVA

Practice address

1555 Port Malabar Blvd NE Ste 102B
Palm Bay, FL 32905-5407

Phone

(321) 725-7188

Fax

(321) 728-1333

NPI assigned

Jun 20, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carl Acquaviva

Title

Pharmacy Dept Manager

Phone

(321) 768-1400

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Acquaviva's LTC Pharmacy Doing business as

Tax ID family

Acquaviva'S LTC Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Carl D Acquaviva

  • Community/Retail Pharmacy
  • Palm Bay, FL
  • NPI 1528203775
  NPD tax ID

Locations

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1780970673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 PORT MALABAR BLVD NE",
            "address_2": "SUITE #102B",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055407",
            "telephone_number": "321-725-7188",
            "fax_number": "321-728-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 PORT MALABAR BLVD NE STE 102B",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055407",
            "telephone_number": "321-725-7188",
            "fax_number": "321-728-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARL D ACQUAVIVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "ACQUAVIVA",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "PHARMACY DEPT MANAGER",
        "authorized_official_telephone_number": "321-768-1400"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH25270",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104293900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acquaviva's LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Acquaviva's LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caretenders Visiting Services of District 7, LLC
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• Carl D Acquaviva
• Carl D Acquaviva
• Anne Elizabeth Carlson, RD
• Tammie S. Carpenter, LMT
• Harriet Z. Carr, LCSW
• Rachel Chanteil Cartechine, M.D.
• Charles Edward Carter

• Long Term Care Pharmacy in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Long Term Care Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.