Provider Demographics
NPI:1558455956
Name:ADVANTAGE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:ADVANTAGE HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEGLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-706-9030
Mailing Address - Street 1:8237 ROCHESTER AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0717
Mailing Address - Country:US
Mailing Address - Phone:909-948-8377
Mailing Address - Fax:909-948-9297
Practice Address - Street 1:8237 ROCHESTER AVE STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0717
Practice Address - Country:US
Practice Address - Phone:909-948-8377
Practice Address - Fax:909-948-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAPHY502383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124917OtherPK
CA1558455956Medicaid
CAPHY59247OtherPHARMACY