1417381294 NPI number — ADVANCED PHARMACY SERVICES, LLC

Table of content: (NPI 1417381294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417381294 NPI number — ADVANCED PHARMACY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PHARMACY SERVICES, 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:
1417381294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYDRO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73048-0421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-663-4111
Provider Business Mailing Address Fax Number:
405-663-4114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4605 QUEBEC ST
Provider Second Line Business Practice Location Address:
SUITE B-11
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80216-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-592-2000
Provider Business Practice Location Address Fax Number:
405-663-4114
Provider Enumeration Date:
08/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ABBOTT
Authorized Official First Name:
KENT
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
405-663-4111

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0000000666 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2141731 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07054220 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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