Provider Demographics
NPI:1902133358
Name:ADVANCED SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:ADVANCED SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CINGORANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-617-5583
Mailing Address - Street 1:102 OXMOOR RD STE 118
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5964
Mailing Address - Country:US
Mailing Address - Phone:205-941-9848
Mailing Address - Fax:205-941-9987
Practice Address - Street 1:102 OXMOOR RD STE 118
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5964
Practice Address - Country:US
Practice Address - Phone:205-941-9848
Practice Address - Fax:205-941-9987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SPECIALTY PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1131003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy