Provider Demographics
NPI:1275532434
Name:ADVANCED PHARMACY
Entity Type:Organization
Organization Name:ADVANCED PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-396-3575
Mailing Address - Street 1:4900 CYPRESS ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7670
Mailing Address - Country:US
Mailing Address - Phone:318-396-3575
Mailing Address - Fax:318-397-1516
Practice Address - Street 1:4900 CYPRESS ST
Practice Address - Street 2:SUITE 12
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7670
Practice Address - Country:US
Practice Address - Phone:318-396-3575
Practice Address - Fax:318-397-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5565333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy