Healthcare Provider Details

I. General information

NPI: 1104409564
Provider Name (Legal Business Name): ADVANCE CARE PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MEDPARK SQUARE DR STE 4
SOMERSET KY
42503-1708
US

IV. Provider business mailing address

25 MEDPARK SQUARE DR STE 4
SOMERSET KY
42503-1708
US

V. Phone/Fax

Practice location:
  • Phone: 606-676-0199
  • Fax: 606-451-7727
Mailing address:
  • Phone: 606-676-0199
  • Fax: 606-451-7727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JODY DUNGAN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 606-676-0199