Provider Demographics
NPI:1336889161
Name:ADVANCED RX LB LLC
Entity type:Organization
Organization Name:ADVANCED RX LB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MANISHKUMAR
Authorized Official - Middle Name:TRIKAMBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-912-4011
Mailing Address - Street 1:2100 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4807
Mailing Address - Country:US
Mailing Address - Phone:562-912-4011
Mailing Address - Fax:951-284-4596
Practice Address - Street 1:2100 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4807
Practice Address - Country:US
Practice Address - Phone:562-912-4011
Practice Address - Fax:951-284-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY60561OtherBOARD OF PHARMACY