Provider Demographics
NPI:1396158895
Name:OLIVA, ADRIAN
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:OLIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1646
Mailing Address - Country:US
Mailing Address - Phone:305-456-8429
Mailing Address - Fax:305-456-8479
Practice Address - Street 1:390 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1646
Practice Address - Country:US
Practice Address - Phone:305-456-8429
Practice Address - Fax:305-456-8479
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28170333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy