Provider Demographics
NPI:1679878169
Name:PHARMADVICE,INC
Entity Type:Organization
Organization Name:PHARMADVICE,INC
Other - Org Name:PHARMACY EXPRESS & MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FORSTER
Authorized Official - Middle Name:EJIKE
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH
Authorized Official - Phone:407-273-0021
Mailing Address - Street 1:10209 E COLONIAL DR STE 180
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4337
Mailing Address - Country:US
Mailing Address - Phone:407-273-0021
Mailing Address - Fax:407-273-0024
Practice Address - Street 1:10209 E COLONIAL DR STE 180
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4337
Practice Address - Country:US
Practice Address - Phone:407-273-0021
Practice Address - Fax:407-273-0024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMADVICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-14
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24474332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001976200Medicaid
FL001976200Medicaid