Provider Demographics
NPI:1023306776
Name:ADVANCED PHARMACY
Entity type:Organization
Organization Name:ADVANCED PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-381-9394
Mailing Address - Street 1:2865 JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2803
Mailing Address - Country:US
Mailing Address - Phone:573-727-9030
Mailing Address - Fax:573-927-9023
Practice Address - Street 1:2865 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2803
Practice Address - Country:US
Practice Address - Phone:573-727-9030
Practice Address - Fax:573-927-9023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRM ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021111333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy