Provider Demographics
NPI:1912193343
Name:ADVANCED PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:ADVANCED PHARMACY SERVICES LLC
Other - Org Name:ADVANCED PHARMACY SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-663-4111
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-0421
Mailing Address - Country:US
Mailing Address - Phone:405-663-4111
Mailing Address - Fax:405-663-4114
Practice Address - Street 1:4605 QUEBEC ST
Practice Address - Street 2:STE B-11
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3405
Practice Address - Country:US
Practice Address - Phone:303-592-2000
Practice Address - Fax:405-663-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CO6663336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07054220Medicaid
1997765OtherPK
4857100002Medicare NSC