Healthcare Provider Details

I. General information

NPI: 1639470362
Provider Name (Legal Business Name): ADVANCED MEDICAL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 NIKKI VIEW DR
BRANDON FL
33511-4879
US

IV. Provider business mailing address

1921 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6509
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2065
  • Fax: 813-374-8884
Mailing address:
  • Phone: 813-876-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY R DENNISON JR.
Title or Position: CEO
Credential: MD, MBA
Phone: 813-374-2065