Provider Demographics
NPI:1174830475
Name:ADVANCED PHARMACY LLC
Entity Type:Organization
Organization Name:ADVANCED PHARMACY LLC
Other - Org Name:ADVANCED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-1190
Mailing Address - Street 1:1576 ATKINSON RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5701
Mailing Address - Country:US
Mailing Address - Phone:770-339-1190
Mailing Address - Fax:888-901-2030
Practice Address - Street 1:350 FEASTER RD STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6176
Practice Address - Country:US
Practice Address - Phone:770-339-1190
Practice Address - Fax:888-610-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC148473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127115OtherPK