Provider Demographics
NPI:1952837619
Name:ADVANTAGE PHARMACY AND WELLNESS LLC
Entity Type:Organization
Organization Name:ADVANTAGE PHARMACY AND WELLNESS LLC
Other - Org Name:ADVANTAGE PHARMACY & WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-407-7637
Mailing Address - Street 1:506 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4428
Mailing Address - Country:US
Mailing Address - Phone:843-407-7637
Mailing Address - Fax:843-669-1054
Practice Address - Street 1:506 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4428
Practice Address - Country:US
Practice Address - Phone:843-407-7637
Practice Address - Fax:843-669-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC171823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176482OtherPK