1487054839 NPI number — ADVANCED RX CORONA LLC

Table of content: (NPI 1487054839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487054839 NPI number — ADVANCED RX CORONA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RX CORONA LLC
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:
6
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:
1487054839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 BONNIE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92878-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-256-8800
Provider Business Mailing Address Fax Number:
951-284-4594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 BONNIE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92878-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-256-8800
Provider Business Practice Location Address Fax Number:
951-284-4594
Provider Enumeration Date:
09/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MANISHKUMAR
Authorized Official Middle Name:
TRIKAMBHAI
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
951-256-8800

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHY60560 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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