Provider Demographics
NPI:1255560512
Name:ADVANCE OUTCOME MANAGEMENT, INC.
Entity type:Organization
Organization Name:ADVANCE OUTCOME MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-799-1266
Mailing Address - Street 1:12792 VALLEY VIEW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2526
Mailing Address - Country:US
Mailing Address - Phone:714-799-1266
Mailing Address - Fax:714-379-1266
Practice Address - Street 1:12792 VALLEY VIEW ST
Practice Address - Street 2:SUITE A
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2526
Practice Address - Country:US
Practice Address - Phone:714-799-1266
Practice Address - Fax:714-379-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499463336H0001X, 3336L0003X, 3336S0011X, 3336C0003X, 333600000X
CA996063336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy