Provider Demographics
NPI:1346544954
Name:ADVANCED WHOLESALE PHARMCAY, INC
Entity type:Organization
Organization Name:ADVANCED WHOLESALE PHARMCAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:813-374-2065
Mailing Address - Street 1:1921 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6509
Mailing Address - Country:US
Mailing Address - Phone:813-876-7600
Mailing Address - Fax:813-876-7675
Practice Address - Street 1:3614 W KENNEDY BLVD
Practice Address - Street 2:STE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2852
Practice Address - Country:US
Practice Address - Phone:813-374-2065
Practice Address - Fax:813-374-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN