MEDICARE: ADVANCED PHARMACY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	0000000666	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141731	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417381294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHARMACY SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	HYDRO
State	:	OK
Zip	:	73048-0421
Country	:	US
Telephone Number	:	405-663-4111
Fax Number	:	405-663-4114

Provider Business Practice Location Address
First Line	:	4605 QUEBEC ST
Second Line	:	SUITE B-11
City	:	DENVER
State	:	CO
Zip	:	80216-3405
Country	:	US
Telephone Number	:	303-592-2000
Fax Number	:	405-663-4114

Authorized Official
Title or Position	:	MANAGER
Name	:	KENT ABBOTT
Credential	:
Telephone Number	:	405-663-4111

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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