Organization
ADVANCED RX LLC
Active
Other names
New Walker's Professional Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FADI NASERDEAN PHARMD, MD (PRESIDENT)
(313) 680-3000
Entity
Organization
Contact information
Practice address
838 4TH AVENUE, LAKE ODESSA, MI 48849
(616) 374-3190
(616) 374-0921
Mailing address
P.O. BOX 660, DEARBORN HEIGHTS, MI 48127
(616) 374-3190
(616) 374-0921
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301005445
MI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021935001
—
MI
01
—
2175188
PK
—
Enumeration date
08/27/2006
Last updated
08/16/2021
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