Organization
ADVANT-EDGE HEALTHCARE
Active
Organization
ADVANT-EDGE HEALTHCARE
Active
Other names
ADVANT EDGE PHARMACY 00002
Organization subpart
No
Provider details
NPI number
Authorized official
EUSTACIO RIVAS (PRESIDENT)
(915) 309-9343
Entity
Organization
Contact information
Practice address
14476 HORIZON BLVD, STE J, HORIZON CITY, TX 79928-8578
(915) 852-8884
(915) 852-1727
Mailing address
14476 HORIZON BLVD, STE J, HORIZON CITY, TX 79928-8578
(915) 852-8884
(915) 852-1727
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25772
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145854
—
TX
01
—
2100496
PK
—
Enumeration date
10/29/2007
Last updated
01/13/2017
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