Organization
ADVANT EDGE PHARMACY, INC
Active
Other names
Advant Edge HME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EUSTACIO RIVAS JR. RPH (PRESIDENT)
(915) 595-0409
Entity
Organization
Contact information
Practice address
1576 LOMALAND DR, EL PASO, TX 79935-4202
(915) 595-0409
(915) 595-1306
Mailing address
1576 LOMALAND, EL PASO, TX 79935
(915) 595-0409
(915) 595-1306
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
19378
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
19378
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
19378
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010965401
—
TX
05
—
016896501
—
TX
Enumeration date
09/06/2005
Last updated
09/10/2012
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