Organization
ADVANCED RX LLC
Active
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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