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General NPI Number Information
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NPI Number | 1629235882
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PHARMACY
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 6375 U S HIGHWAY 98 SUITE 50
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City | HATTIESBURG
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State | MS
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Zip | 39402-7410
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Country | US
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Telephone | 601-268-1422
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Fax | 601-268-1424
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Provider Business Mailing Address
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Address Line | 6375 U S HIGHWAY 98 SUITE 50
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City | HATTIESBURG
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State | MS
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Zip | 39402-7410
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Country | US
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Telephone | 601-268-1422
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Fax | 601-268-1424
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Authorized Official
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Title or Position | MANG PARTNER
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Name | GLENN BEACH
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Credential |
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Telephone | 601-268-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order 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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 07726011
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License Number State | MS
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