Provider Demographics
NPI:1437469525
Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Other - Org Name:ADVENTHEALTH OUTPATIENT PHARMACY EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-303-7388
Mailing Address - Street 1:PO BOX 540419
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854
Mailing Address - Country:US
Mailing Address - Phone:407-303-8676
Mailing Address - Fax:407-303-8682
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 125
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8202
Practice Address - Country:US
Practice Address - Phone:407-303-8676
Practice Address - Fax:407-303-8682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM-SUNBELT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-07
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 248773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002879100Medicaid
FL0785540006Medicare NSC