Provider Demographics
NPI:1932642543
Name:ADVANCE CARE RX LLC
Entity Type:Organization
Organization Name:ADVANCE CARE RX LLC
Other - Org Name:ADVANCE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/STAFF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:941-212-6666
Mailing Address - Street 1:7016 US 301 N
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3030
Mailing Address - Country:US
Mailing Address - Phone:941-212-6666
Mailing Address - Fax:
Practice Address - Street 1:7016 US 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3030
Practice Address - Country:US
Practice Address - Phone:407-271-2138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FL304653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021396800Medicaid
2166692OtherPK