Provider Demographics
NPI:1093002057
Name:ALLIANCE MEDICATION SERVICES, LLC.
Entity Type:Organization
Organization Name:ALLIANCE MEDICATION SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-668-8820
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18214-0222
Mailing Address - Country:US
Mailing Address - Phone:570-668-8820
Mailing Address - Fax:570-668-8825
Practice Address - Street 1:88 MAHANOY AVE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4002
Practice Address - Country:US
Practice Address - Phone:866-668-8590
Practice Address - Fax:570-668-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482133333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP482133OtherBOARD OF PHARMACY