Provider Demographics
NPI:1396863478
Name:FZAIPAN INC
Entity Type:Organization
Organization Name:FZAIPAN INC
Other - Org Name:ADVANCED RX & COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHRM DIR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-448-8181
Mailing Address - Street 1:6951 SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2819
Mailing Address - Country:US
Mailing Address - Phone:904-448-8181
Mailing Address - Fax:904-448-6662
Practice Address - Street 1:6951 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2819
Practice Address - Country:US
Practice Address - Phone:904-448-8181
Practice Address - Fax:904-448-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336S0011X
FLPH184623336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2014530OtherPK