Provider Demographics
NPI:1760493316
Name:ADVANCED PHYSICANS SOLUTIONS INC
Entity Type:Organization
Organization Name:ADVANCED PHYSICANS SOLUTIONS INC
Other - Org Name:ADVANCED COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-922-0272
Mailing Address - Street 1:4335 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3727
Mailing Address - Country:US
Mailing Address - Phone:818-982-2813
Mailing Address - Fax:866-837-4530
Practice Address - Street 1:7225 FULTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4111
Practice Address - Country:US
Practice Address - Phone:818-982-2813
Practice Address - Fax:866-219-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY485913336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5601530OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1760493316Medicaid
5439640001Medicare NSC