Organization
ADVANCED RX MANAGEMENT
Active
Other names
Advanced RX 064
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM GIRAULT (PROGRAM MANAGER)
(813) 543-9041
Entity
Organization
Contact information
Practice address
5315 AVION PARK DR STE 120, TAMPA, FL 33607-1461
(813) 543-9043
(925) 522-2930
Mailing address
3501 E FRONTAGE RD STE 100, TAMPA, FL 33607-1704
(813) 543-9041
(925) 522-2930
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
WLS 5655
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568748010
461529015
FL
01
—
1568748010
NON-DISPENSING PHARMACY LOCATION
—
Enumeration date
10/28/2011
Last updated
06/26/2023
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