Provider Demographics
NPI:1831127414
Name:ADVANCED PHARMACY HOMECARE, INC.
Entity Type:Organization
Organization Name:ADVANCED PHARMACY HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEICHTFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-741-2813
Mailing Address - Street 1:2127 E VALLEY PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2775
Mailing Address - Country:US
Mailing Address - Phone:760-741-2813
Mailing Address - Fax:760-741-2061
Practice Address - Street 1:2127 E VALLEY PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2775
Practice Address - Country:US
Practice Address - Phone:760-741-2813
Practice Address - Fax:760-741-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 43316332B00000X, 332BX2000X, 333600000X
CALSC 99045332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA433160Medicaid
CA0570754OtherNABP
CALSC 99045OtherSTERILE COMPOUNDING LICEN
CAPHY 43316OtherRETAIL PHARMACY PERMIT
CAPHY 43316OtherRETAIL PHARMACY PERMIT