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General NPI Number Information
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NPI Number | 1316501638
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Entity Type | Organization
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Legal Business Name | ADVANTA HEALTH CARE, INC.
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 4100 MAPLESHADE LN
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City | PLANO
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State | TX
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Zip | 75093-0012
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Country | US
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Telephone | 346-267-7214
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 ROSS AVE
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City | DALLAS
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State | TX
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Zip | 75206-7762
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | ANIL VIRANI
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Credential |
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Telephone | 346-267-7214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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