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General NPI Number Information
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NPI Number | 1023306776
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Entity Type | Organization
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Legal Business Name | ADVANCED PHARMACY
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 2865 JAMES BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2803
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Country | US
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Telephone | 573-727-9030
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Fax | 573-927-9023
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Provider Business Mailing Address
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Address Line | 2865 JAMES BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2803
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Country | US
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Telephone | 573-727-9030
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Fax | 573-927-9023
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMAD ATTIQUE
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Credential |
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Telephone | 314-381-9394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2011021111
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License Number State | MO
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