Provider Demographics
NPI:1306357843
Name:ADVANCE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:ADVANCE PHARMACY SERVICES INC
Other - Org Name:MONTCLAIR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHAVIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMBASEEYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-920-0100
Mailing Address - Street 1:5404 MORENO ST STE F
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1665
Mailing Address - Country:US
Mailing Address - Phone:909-920-0100
Mailing Address - Fax:909-920-0120
Practice Address - Street 1:5404 MORENO ST STE F
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1665
Practice Address - Country:US
Practice Address - Phone:909-920-0100
Practice Address - Fax:909-920-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55834OtherBOARD OF PHARMACY PERMIT
CA4303741Medicaid