Provider Demographics
NPI:1811205081
Name:ADVANCED PHARMACY CONCEPTS, LLC
Entity Type:Organization
Organization Name:ADVANCED PHARMACY CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-395-0043
Mailing Address - Street 1:1018 S BATESVILLE RD # 4-A
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4586
Mailing Address - Country:US
Mailing Address - Phone:864-990-2880
Mailing Address - Fax:888-258-9585
Practice Address - Street 1:1018 S BATESVILLE RD # 4-A
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4586
Practice Address - Country:US
Practice Address - Phone:864-990-2880
Practice Address - Fax:888-258-9585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST RX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
SC138193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC715019Medicaid