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General NPI Number Information
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NPI Number | 1588444731
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Entity Type | Organization
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Legal Business Name | ADVANCED PHARMACY GROUP INC.
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 15555 MAIN ST STE D8
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City | HESPERIA
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State | CA
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Zip | 92345-3423
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Country | US
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Telephone | 760-948-1000
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Fax | 760-948-2000
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Provider Business Mailing Address
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Address Line | 15555 MAIN ST STE D8
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City | HESPERIA
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State | CA
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Zip | 92345-3423
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Country | US
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Telephone | 760-948-1000
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Fax | 760-948-2000
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Authorized Official
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Title or Position | CEO
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Name | TONY IBRAHIM
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Credential |
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Telephone | 760-987-6796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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