Provider Demographics
NPI:1922429562
Name:ADVANCE PHARMACY SERVICE LLC
Entity Type:Organization
Organization Name:ADVANCE PHARMACY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOAA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-350-9999
Mailing Address - Street 1:4910 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1402
Mailing Address - Country:US
Mailing Address - Phone:813-350-9999
Mailing Address - Fax:813-350-9990
Practice Address - Street 1:4910 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1402
Practice Address - Country:US
Practice Address - Phone:813-350-9999
Practice Address - Fax:813-350-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-29
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH27326333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy