Provider Demographics
NPI:1487054839
Name:ADVANCED RX CORONA LLC
Entity type:Organization
Organization Name:ADVANCED RX CORONA 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:951-256-8800
Mailing Address - Street 1:320 BONNIE CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-4374
Mailing Address - Country:US
Mailing Address - Phone:951-256-8800
Mailing Address - Fax:951-284-4594
Practice Address - Street 1:320 BONNIE CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-4374
Practice Address - Country:US
Practice Address - Phone:951-256-8800
Practice Address - Fax:951-284-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY60560OtherBOARD OF PHARMACY