Provider Demographics
NPI:1558455956
Name:ADVANTAGE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ADVANTAGE HEALTHCARE SERVICES LLC
Other - Org Name:CUCAMONGA COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JASANI
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:909-948-8377
Mailing Address - Street 1:8237 ROCHESTER AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0717
Mailing Address - Country:US
Mailing Address - Phone:909-948-8377
Mailing Address - Fax:909-948-9297
Practice Address - Street 1:8237 ROCHESTER AVE STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0717
Practice Address - Country:US
Practice Address - Phone:909-948-8377
Practice Address - Fax:909-948-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY502383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59247OtherPHARMACY
2124917OtherPK
CA1558455956Medicaid