Healthcare Provider Details

I. General information

NPI: 1417635087
Provider Name (Legal Business Name): ADVANCE COMMUNITY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S SALEM ST
APEX NC
27502-1825
US

IV. Provider business mailing address

1001 ROCK QUARRY RD
RALEIGH NC
27610-3825
US

V. Phone/Fax

Practice location:
  • Phone: 919-755-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TONCHELLE RENEE LUCAS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 919-250-2978