Organization
ADVANT-EDGE PHARMACY, INC
Active
Other names
ADVANT EDGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EUSTACIO RIVAS (PRESIDENT)
(915) 595-0409
Entity
Organization
Contact information
Practice address
1576 LOMALAND DR, EL PASO, TX 79935-4202
(915) 595-0409
(915) 595-1028
Mailing address
1576 LOMALAND DR, EL PASO, TX 79935-4202
(915) 595-0409
(915) 595-1028
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19378
TX
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144844
—
TX
01
—
2091866
PK
—
Enumeration date
11/01/2006
Last updated
11/13/2023
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