1922319383 NPI number — ADVANCE PHARMACY SERVICES PLLC

Table of content: (NPI 1922319383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922319383 NPI number — ADVANCE PHARMACY SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE PHARMACY SERVICES PLLC
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:
ADVANCE PHARMACY SERVICES
Provider Other Organization Name Type Code:
3
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:
1922319383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1838 ELM HILL PIKE
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37210-3726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-433-5190
Provider Business Mailing Address Fax Number:
888-208-1097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 N PARKWAY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-433-5190
Provider Business Practice Location Address Fax Number:
888-208-1097
Provider Enumeration Date:
06/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GRACE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
731-664-0002

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4777 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4443317 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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