Most Relevant Information
Provider Data
| NPI Number: | 1003211947 |
| Provider Name: | CARLY ACQUAVIVA PHARM. D |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | PS51839 |
Most Important Dates
| Enumeration Date: | 11/04/2014 |
| Last Updated: | 11/04/2014 |
Provider Practice Location
1555 PORT MALABAR BLVD NE
SUITE 101
PALM BAY
FL
329055407
Practice Location Phone/Fax
| Phone: | 3217257188 |
| Fax: |
Provider Mailing Location
1555 PORT MALABAR BLVD NE
SUITE 101
PALM BAY
FL
329055407
Provider Mailing Phone/Fax
| Phone: | 3217257188 |
| Fax: |