Provider Demographics
NPI:1265447817
Name:ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:407-357-2600
Mailing Address - Street 1:5050 WESLEY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5908
Mailing Address - Country:US
Mailing Address - Phone:407-357-2600
Mailing Address - Fax:407-805-8545
Practice Address - Street 1:5050 WESLEY RD STE 110
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5908
Practice Address - Country:US
Practice Address - Phone:866-943-4535
Practice Address - Fax:407-805-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X
FLPH221003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012515OtherPK
FL006452500Medicaid