Healthcare Provider Details

I. General information

NPI: 1245239029
Provider Name (Legal Business Name): AMBULATORY PHARMACEUTICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date: 04/08/2010
Reactivation Date: 09/09/2010

III. Provider practice location address

85 EXECUTIVE BLVD SUITE A
ELMSFORD NY
10523-1326
US

IV. Provider business mailing address

3101 GAYLORD PKWY MAILSTOP 1E-E144
FRISCO TX
75034-8655
US

V. Phone/Fax

Practice location:
  • Phone: 914-789-2901
  • Fax: 914-789-5040
Mailing address:
  • Phone: 469-365-8300
  • Fax: 469-365-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number021933
License Number StateNY

VIII. Authorized Official

Name: MR. MARK O. JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 469-365-8300