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Shivoam Llc
Compounding Pharmacy in Deland, Florida
NPI 1134194202

Shivoam Llc is a Compounding Pharmacy based in Deland, FL and is specialized in Compounding Pharmacy. Shivoam Llc practices in Deland, FL. The NPI Number for Shivoam Llc is 1134194202 and holds a License No. PH11083 (Florida).

The current practice location address for Shivoam Llc is 319 S Woodland Blvd, Deland, FL and can be reached out via phone at 386-734-3383 and via fax at 386-734-3384.

Location: 319 S Woodland Blvd, Deland, FL, 32720
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1134194202
Provider Name
Shivoam Llc
Credential
Provider Entity Type
Organization
Address
319 S Woodland Blvd, Deland, FL, 32720
Phone Number
386-734-3383
Fax Number
386-734-3384
Provider Enumeration Date
02/21/2006
Last Update Date
02/15/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
1064512 01 OTHER ID NUMBER-COMMERCIAL NUMBER
109020800 05 FL
institution
Provider Business Practice Location Address Details
Address
319 S Woodland Blvd
City
Deland
State
Florida
Zip
32720
Phone Number
386-734-3383
Fax Number
386-734-3384
person
Provider Business Mailing Address Details
Address
319 S Woodland Blvd
City
Deland
State
Florida
Zip
32720
Phone Number
386-734-3383
Fax Number
386-734-3384
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Durable Medical Equipment & Medical Supplies
Speciality
-
Taxonomy
332B00000X
License No.
PH11083 (Florida)
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Pharmacy
Speciality
Community/Retail Pharmacy
Taxonomy
3336C0003X
License No.
PH11083 (Florida)
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Pharmacy
Speciality
Compounding Pharmacy
Taxonomy
3336C0004X
License No.
PH11083 (Florida)
Definition
A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.
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