Organization
YOUR COMPOUNDING PHARMACY, LLC
Active
Other names
ADVance Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ALBERT KODMAN (CEO)
(724) 463-9300
Entity
Organization
Contact information
Practice address
280 INDIAN SPRINGS RD, SUITE 125, INDIANA, PA 15701-3676
(724) 463-9300
(724) 463-9301
Mailing address
280 INDIAN SPRINGS RD, SUITE 125, INDIANA, PA 15701-3676
(724) 463-9300
(724) 463-9301
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
PP414041L
PA
3336C0004X
Compounding Pharmacy
PP414041L
PA
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0180749
—
OH
05
—
102834523002
—
PA
01
—
PP414041L
PA STATE PHARMACY PERMIT
PA
Enumeration date
04/09/2007
Last updated
03/30/2023
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