# PHARMASOURCE LTC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043789431
- **Authorized official:** DR. FADI NASERDEAN (PRINCIPAL)
- **Authorized official phone:** (734) 261-4100

## Contact information

- **Practice address:** 31620 GRAND RIVER AVE, FARMINGTON, MI 48336-4234
- **Practice address phone:** (313) 680-3000
- **Mailing address:** 31620 GRAND RIVER AVE, FARMINGTON, MI 48336-4234
- **Mailing address phone:** (734) 261-4100
- **Mailing address fax:** (734) 261-0404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2018
- **Last updated:** 01/22/2020