Provider Demographics
NPI:1093827099
Name:ADVANCED PHARMACY PLUS
Entity Type:Organization
Organization Name:ADVANCED PHARMACY PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASERDEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-624-3016
Mailing Address - Street 1:5728 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2298
Mailing Address - Country:US
Mailing Address - Phone:313-624-3016
Mailing Address - Fax:313-582-6717
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-624-3016
Practice Address - Fax:313-582-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007103333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2360674Medicaid
2360674OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI4842270001Medicare NSC