MEDICARE: ADVANCE PHARMACY SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PH27326	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922429562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE PHARMACY SERVICE LLC

Provider Business Mailing Address
First Line	:	4910 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1402
Country	:	US
Telephone Number	:	813-350-9999
Fax Number	:	813-350-9990

Provider Business Practice Location Address
First Line	:	4907 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1401
Country	:	US
Telephone Number	:	813-350-9999
Fax Number	:	813-350-9990

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DOAA KOTB
Credential	:
Telephone Number	:	813-350-9999

Provider Enumeration Date	:	12/29/2013
Last Update Date	:	05/07/2025

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