Healthcare Provider Details

I. General information

NPI: 1255560512
Provider Name (Legal Business Name): ADVANCE OUTCOME MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12792 VALLEY VIEW ST SUITE A
GARDEN GROVE CA
92845-2526
US

IV. Provider business mailing address

12792 VALLEY VIEW ST SUITE A
GARDEN GROVE CA
92845-2526
US

V. Phone/Fax

Practice location:
  • Phone: 714-799-1266
  • Fax: 714-379-1266
Mailing address:
  • Phone: 714-799-1266
  • Fax: 714-379-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number49946
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number49946
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number99606
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number49946
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number49946
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number49946
License Number StateCA

VIII. Authorized Official

Name: DR. CLARENCE LEE LLOYD
Title or Position: PRESIDENT/CFO
Credential: PHARM.D.
Phone: 714-799-1266