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Organization
PHARMASOURCE LTC LLC
Active
Organization
PHARMASOURCE LTC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FADI NASERDEAN (PRINCIPAL)
(734) 261-4100
Entity
Organization
Contact information
Practice address
31620 GRAND RIVER AVE, FARMINGTON, MI 48336-4234
(313) 680-3000
Mailing address
31620 GRAND RIVER AVE, FARMINGTON, MI 48336-4234
(734) 261-4100
(734) 261-0404
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Enumeration date
11/15/2018
Last updated
01/22/2020
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