Provider Demographics
NPI:1093919151
Name:ADVANCED MEDICAL THERAPEUTICS PHARMACY
Entity Type:Organization
Organization Name:ADVANCED MEDICAL THERAPEUTICS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:866-828-8203
Mailing Address - Street 1:3505 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5702
Mailing Address - Country:US
Mailing Address - Phone:719-262-0022
Mailing Address - Fax:719-955-1490
Practice Address - Street 1:4217 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8453
Practice Address - Country:US
Practice Address - Phone:866-828-8203
Practice Address - Fax:704-824-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy