1093919151 NPI number — ADVANCED MEDICAL THERAPEUTICS PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093919151 NPI number — ADVANCED MEDICAL THERAPEUTICS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL THERAPEUTICS PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093919151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 AUSTIN BLUFFS PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80918-5702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-262-0022
Provider Business Mailing Address Fax Number:
719-955-1490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4217 S NEW HOPE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28056-8453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-828-8203
Provider Business Practice Location Address Fax Number:
704-824-1874
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GENTILE
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
866-828-8203

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  8788 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com