=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518051960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENTIST HEALTH SYSTEM-SUNBELT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 N. ORANGE AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-4640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-303-2559
-----------------------------------------------------
Fax | 407-303-2568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 540419
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-303-2559
-----------------------------------------------------
Fax | 407-303-2568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. HOWARD SMITH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 407-303-7388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH8627
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------