Provider Demographics
NPI:1558092288
Name:ADVOCATE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ADVOCATE HEALTH SERVICES, INC.
Other - Org Name:AMBERWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-360-5586
Mailing Address - Street 1:800 RAVENHILL DR , SUITE 101
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-9204
Mailing Address - Country:US
Mailing Address - Phone:913-360-5586
Mailing Address - Fax:
Practice Address - Street 1:800 RAVENHILL DR , SUITE 101
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9204
Practice Address - Country:US
Practice Address - Phone:913-367-1654
Practice Address - Fax:913-367-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies