Healthcare Provider Details

I. General information

NPI: 1235585662
Provider Name (Legal Business Name): ADVANCE COMMUNITY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 ROCK QUARRY RD
RALEIGH NC
27610-3825
US

IV. Provider business mailing address

1011 ROCK QUARRY RD
RALEIGH NC
27610-3825
US

V. Phone/Fax

Practice location:
  • Phone: 919-755-5060
  • Fax: 919-573-0041
Mailing address:
  • Phone: 919-755-5060
  • Fax: 919-573-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13075
License Number StateNC

VIII. Authorized Official

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