Provider Demographics
NPI:1982699971
Name:ADVANCED PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:ADVANCED PHARMACY SERVICES LLC
Other - Org Name:ADVANCED PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-663-4111
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-0421
Mailing Address - Country:US
Mailing Address - Phone:405-663-4111
Mailing Address - Fax:970-242-0929
Practice Address - Street 1:237 S 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3601
Practice Address - Country:US
Practice Address - Phone:970-242-4484
Practice Address - Fax:970-242-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
CO5300000233336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07054220Medicaid
1997764OtherPK
CO07054220Medicaid