Provider Demographics
NPI:1912292848
Name:ALLIANCE PRESCRIPTION SERVICES INC
Entity Type:Organization
Organization Name:ALLIANCE PRESCRIPTION SERVICES INC
Other - Org Name:MEDSTOP PHARMACY & SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-552-2278
Mailing Address - Street 1:1330 JEROME AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452
Mailing Address - Country:US
Mailing Address - Phone:718-552-2278
Mailing Address - Fax:718-552-2280
Practice Address - Street 1:1330 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3316
Practice Address - Country:US
Practice Address - Phone:718-552-2278
Practice Address - Fax:718-552-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0307443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5802699OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03349199Medicaid
5802699OtherNCPDP PROVIDER IDENTIFICATION NUMBER