Provider Demographics
NPI:1922319383
Name:ADVANCE PHARMACY SERVICES PLLC
Entity Type:Organization
Organization Name:ADVANCE PHARMACY SERVICES PLLC
Other - Org Name:ADVANCE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-664-0002
Mailing Address - Street 1:1838 ELM HILL PIKE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-3726
Mailing Address - Country:US
Mailing Address - Phone:877-433-5190
Mailing Address - Fax:888-208-1097
Practice Address - Street 1:317 N PARKWAY STE 400
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2713
Practice Address - Country:US
Practice Address - Phone:877-433-5190
Practice Address - Fax:888-208-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
TN47773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4443317OtherNCPDP PROVIDER IDENTIFICATION NUMBER