Basic Information
| Provider Information | |||||||||
| NPI: | 1750788915 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED PAIN MANAGEMENT SC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | APM PHARMACY SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4131 W LOOMIS RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143253725 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4131 W LOOMIS RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143257246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | LAL | ||||||||
| AuthorizedOfficialFirstName: | VISHAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4143257246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 9287-42 | WI | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.