Provider Demographics
NPI:1033150891
Name:BSAP LLC
Entity Type:Organization
Organization Name:BSAP LLC
Other - Org Name:ADVANCE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-722-3562
Mailing Address - Street 1:110 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-8343
Mailing Address - Country:US
Mailing Address - Phone:573-722-3562
Mailing Address - Fax:573-722-3569
Practice Address - Street 1:110 S OAK ST
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730-8343
Practice Address - Country:US
Practice Address - Phone:573-722-3562
Practice Address - Fax:573-722-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO20090023223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050340OtherPK
2619976OtherNCPDP PROVIDER IDENTIFICATION NUMBER