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General NPI Number Information
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NPI Number | 1104409564
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Entity Type | Organization
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Legal Business Name | ADVANCE CARE PHARMACY PLLC
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 25 MEDPARK SQUARE DR STE 4
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City | SOMERSET
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State | KY
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Zip | 42503-1708
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Country | US
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Telephone | 606-676-0199
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Fax | 606-451-7727
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Provider Business Mailing Address
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Address Line | 25 MEDPARK SQUARE DR STE 4
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City | SOMERSET
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State | KY
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Zip | 42503-1708
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Country | US
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Telephone | 606-676-0199
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Fax | 606-451-7727
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. JODY DUNGAN
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Credential | PHARM.D.
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Telephone | 606-676-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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