Provider Demographics
NPI:1356019707
Name:ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WEATHERBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-357-2618
Mailing Address - Street 1:582 MONROE RD STE 1412B
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8821
Mailing Address - Country:US
Mailing Address - Phone:866-943-4535
Mailing Address - Fax:
Practice Address - Street 1:582 MONROE RD STE 1412B
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-8821
Practice Address - Country:US
Practice Address - Phone:866-943-4535
Practice Address - Fax:407-805-8545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013184500Medicaid