Provider Demographics
NPI:1477968980
Name:ADVANTAGE APOTHECARY, LLCF
Entity Type:Organization
Organization Name:ADVANTAGE APOTHECARY, LLCF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-450-0294
Mailing Address - Street 1:5296 OLD HIGHWAY 11 STE 4
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8380
Mailing Address - Country:US
Mailing Address - Phone:601-450-0294
Mailing Address - Fax:601-450-0295
Practice Address - Street 1:5296 OLD HIGHWAY 11 STE 4
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8380
Practice Address - Country:US
Practice Address - Phone:601-450-0294
Practice Address - Fax:601-450-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13438/2.23336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS13438/2.2OtherSTATE BOARD PHARMACY PERMIT
MSCS13438/2.2OtherSTATE PHARMACY CONTROL SUBSTANCE PERMIT