Organization
ADVANCED MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANCE WALL RPH (PRESIDENT AND CEO)
(678) 689-2388
Entity
Organization
Contact information
Practice address
2820 AUGUSTA RD, LANGLEY, SC 29834
(803) 593-3411
(803) 593-6090
Mailing address
PO BOX 1860, LANGLEY, SC 29834-1860
(803) 593-3411
(678) 689-1459
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9181
SC
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2089399
PK
—
05
—
7-9181-7
—
SC
Enumeration date
02/22/2006
Last updated
04/11/2018
About Stedi
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