Provider Demographics
NPI:1134145964
Name:ADVANCED HOME IV SERVICES
Entity Type:Organization
Organization Name:ADVANCED HOME IV SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:501-336-8350
Mailing Address - Street 1:1235 STURGIS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9688
Mailing Address - Country:US
Mailing Address - Phone:501-336-8350
Mailing Address - Fax:501-336-8571
Practice Address - Street 1:1235 STURGIS RD STE 7
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-9688
Practice Address - Country:US
Practice Address - Phone:501-336-8350
Practice Address - Fax:501-336-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20276332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4196550001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER