Provider Demographics
NPI:1306047840
Name:ADVANCED DOCTORS PRESCRIBED PHARMACY
Entity type:Organization
Organization Name:ADVANCED DOCTORS PRESCRIBED PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLIUS
Authorized Official - Middle Name:IHEKWUABA
Authorized Official - Last Name:ANUNOBI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMACIST
Authorized Official - Phone:210-615-3600
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:METHODIST PLAZA SUITE 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-615-3600
Mailing Address - Fax:210-615-3601
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:METHODIST PLAZA SUITE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-615-3600
Practice Address - Fax:210-615-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145794Medicaid