Provider Demographics
NPI:1831439967
Name:ADVANCED FAMILY PHARMACY INC
Entity type:Organization
Organization Name:ADVANCED FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-222-8303
Mailing Address - Street 1:5191 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7502
Mailing Address - Country:US
Mailing Address - Phone:559-222-8303
Mailing Address - Fax:559-222-1082
Practice Address - Street 1:5191 N 6TH ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7502
Practice Address - Country:US
Practice Address - Phone:559-222-8303
Practice Address - Fax:559-222-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
CAPHY 519923336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56-46712OtherNCPDP PROVIDER
CAPHY 51992OtherBOARD OF PHARMACY PERMIT