Provider Demographics
NPI:1073746608
Name:UNIVERSAL ARTS PHARMACY INC
Entity type:Organization
Organization Name:UNIVERSAL ARTS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:SEVERINO
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:305-556-2673
Mailing Address - Street 1:14350 NW 56TH CT
Mailing Address - Street 2:UNIT 114
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2353
Mailing Address - Country:US
Mailing Address - Phone:305-556-2673
Mailing Address - Fax:305-556-9749
Practice Address - Street 1:14350 NW 56TH CT
Practice Address - Street 2:UNIT 114
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2353
Practice Address - Country:US
Practice Address - Phone:305-556-2673
Practice Address - Fax:305-556-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336S0011X
FLPH00139963336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1078737OtherNCPDP PROVIDER IDENTIFICATION NUMBER