Provider Demographics
NPI:1467880880
Name:ADVANCE MEDICAL RX INC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL RX INC
Other - Org Name:ADVANCED MEDICAL RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOANG TRUNG
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-571-7672
Mailing Address - Street 1:9122 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1920
Mailing Address - Country:US
Mailing Address - Phone:626-571-7672
Mailing Address - Fax:626-571-7679
Practice Address - Street 1:9122 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1920
Practice Address - Country:US
Practice Address - Phone:626-571-7672
Practice Address - Fax:626-571-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X
CALSC997743336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58028OtherBOARD OF PHARMACY
2145962OtherPK
740034001Medicare PIN