Organization
ADVANCED SPECIALTY COMPOUND RX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASSAM YOUSSEF (OWNER)
(810) 732-4449
Entity
Organization
Contact information
Practice address
1260 S LINDEN RD, FLINT, MI 48532-3407
(810) 732-4449
(810) 732-8188
Mailing address
1260 S LINDEN RD, FLINT, MI 48532-3407
(810) 732-4449
(810) 732-8188
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
5301011022
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167410
PK
—
Enumeration date
01/24/2017
Last updated
02/14/2017
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