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General NPI Number Information
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NPI Number | 1396659694
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Entity Type | Organization
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Legal Business Name | PHARMA ADVANTAGE LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 22466 THOUSAND PINES LN
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City | BOCA RATON
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State | FL
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Zip | 33428-3803
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Country | US
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Telephone | 501-529-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 S MINTLE ST TRLR 42
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City | AIRWAY HEIGHTS
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State | WA
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Zip | 99001-5262
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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 | MANAGER
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Name | BRYAN LARA
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Credential |
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Telephone | 501-529-1684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | NULL
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