Healthcare Provider Details

I. General information

NPI: 1477968980
Provider Name (Legal Business Name): ADVANTAGE APOTHECARY, LLCF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5296 OLD HIGHWAY 11 STE 4
HATTIESBURG MS
39402-8380
US

IV. Provider business mailing address

5296 OLD HIGHWAY 11 STE 4
HATTIESBURG MS
39402-8380
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-0294
  • Fax: 601-450-0295
Mailing address:
  • Phone: 601-450-0294
  • Fax: 601-450-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number13438/2.2
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number13438/2.2
License Number StateMS

VIII. Authorized Official

Name: WILLIAM C. PIERCE
Title or Position: PIC
Credential: PHARMD
Phone: 601-450-0294