Organization
ADVANTIUM PHARMACY LLC
Active
Other names
Advanced Rx Pharmacy 025
Organization subpart
No
Provider details
NPI number
Authorized official
KATI GAINOUS (PHARMACY PROGRAM ADMINISTRATOR)
(925) 621-2902
Entity
Organization
Contact information
Practice address
5651 FRIST BLVD STE 717, HERMITAGE, TN 37076-2061
(615) 872-9966
(615) 872-9967
Mailing address
C/O ADVANCED RX MANAGEMENT, 4683 CHABOT DRIVE, #200, PLEASANTON, CA 94588
(925) 621-2909
(925) 269-8423
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0000005360
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146606
PK
—
Enumeration date
06/12/2014
Last updated
11/03/2014
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