Provider Demographics
NPI:1992057442
Name:ADVANCE MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ADVANCE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:BETITA
Authorized Official - Last Name:DANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-722-1079
Mailing Address - Street 1:5111 ROLLING FIELD CT
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4608
Mailing Address - Country:US
Mailing Address - Phone:916-722-1079
Mailing Address - Fax:916-722-1079
Practice Address - Street 1:5111 ROLLING FIELD CT
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4608
Practice Address - Country:US
Practice Address - Phone:916-722-1079
Practice Address - Fax:916-722-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy