Advant-Edge Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

19378 Issued in TX

Legal business name

ADVANT-EDGE PHARMACY, INC

Doing business as

ADVANT EDGE PHARMACY

Practice address

1576 Lomaland Dr
El Paso, TX 79935-4202

Phone

(915) 595-0409

Fax

(915) 595-1028

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eustacio Rivas

Title

President

Phone

(915) 595-0409

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• ADVANT EDGE PHARMACY Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1003994518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1576 LOMALAND DR",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799354202",
            "telephone_number": "915-595-0409",
            "fax_number": "915-595-1028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1576 LOMALAND DR",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799354202",
            "telephone_number": "915-595-0409",
            "fax_number": "915-595-1028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANT-EDGE PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "EUSTACIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "915-595-0409"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "19378",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2091866",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144844",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANT EDGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADVANT EDGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in El Paso, TX
• Providers in El Paso, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.