Provider Demographics
NPI:1245239029
Name:AMBULATORY PHARMACEUTICAL SERVICES
Entity Type:Organization
Organization Name:AMBULATORY PHARMACEUTICAL SERVICES
Other - Org Name:US BIOSERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:O
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-365-8300
Mailing Address - Street 1:3101 GAYLORD PKWY
Mailing Address - Street 2:MAILSTOP 1E-E144
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8655
Mailing Address - Country:US
Mailing Address - Phone:469-365-8300
Mailing Address - Fax:469-365-8320
Practice Address - Street 1:85 EXECUTIVE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1326
Practice Address - Country:US
Practice Address - Phone:914-789-2901
Practice Address - Fax:914-789-5040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IHS ACQUISITION XXX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-14
Last Update Date:2010-09-09
Deactivation Date:2010-04-08
Deactivation Code:
Reactivation Date:2010-09-09
Provider Licenses
StateLicense IDTaxonomies
NY021933333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02255856Medicaid
NY1245239029Medicare PIN
NY02255856Medicaid