=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568748010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED RX MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2011
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5315 AVION PARK DR STE 120
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33607-1461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-543-9043
-----------------------------------------------------
Fax | 925-522-2930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3501 E FRONTAGE RD STE 100
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33607-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-543-9041
-----------------------------------------------------
Fax | 925-522-2930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | ADAM GIRAULT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-543-9041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336M0003X
-----------------------------------------------------
Taxonomy Name | Managed Care Organization Pharmacy
-----------------------------------------------------
License Number | WLS 5655
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------