Provider Demographics
NPI:1083759559
Name:ADVANCE FLORIDA MEDICAL SUPPLIES INC D/B/A ADVANCE FLORIDA PHARMACY
Entity Type:Organization
Organization Name:ADVANCE FLORIDA MEDICAL SUPPLIES INC D/B/A ADVANCE FLORIDA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-685-5854
Mailing Address - Street 1:490 OPA LOCKA BLVD
Mailing Address - Street 2:10
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3563
Mailing Address - Country:US
Mailing Address - Phone:305-685-5854
Mailing Address - Fax:305-685-5854
Practice Address - Street 1:490 OPA LOCKA BLVD
Practice Address - Street 2:10
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3563
Practice Address - Country:US
Practice Address - Phone:305-685-5854
Practice Address - Fax:305-681-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH 24169333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5920530001Medicare NSC