Organization
ADVANTIUM PHARMACY LLC
Active
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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