Healthcare Provider Details

I. General information

NPI: 1396659694
Provider Name (Legal Business Name): PHARMA ADVANTAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22466 THOUSAND PINES LN
BOCA RATON FL
33428-3803
US

IV. Provider business mailing address

1913 S MINTLE ST TRLR 42
AIRWAY HEIGHTS WA
99001-5262
US

V. Phone/Fax

Practice location:
  • Phone: 501-529-1684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRYAN LARA
Title or Position: MANAGER
Credential:
Phone: 501-529-1684