Provider Demographics
NPI:1336154954
Name:ADVANTAGE PHARMACY SOLUTIONS LLC
Entity type:Organization
Organization Name:ADVANTAGE PHARMACY SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENRIECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-216-9502
Mailing Address - Street 1:1417 BRACE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3524
Mailing Address - Country:US
Mailing Address - Phone:856-796-9500
Mailing Address - Fax:856-795-7771
Practice Address - Street 1:1417 BRACE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3524
Practice Address - Country:US
Practice Address - Phone:856-796-9500
Practice Address - Fax:856-795-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NJ28RS006723003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0153648Medicaid
3144336OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA1021560770001Medicaid
PA1021560770001Medicaid