Provider Demographics
NPI:1144749425
Name:ADVANCED RX LLC
Entity Type:Organization
Organization Name:ADVANCED RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASERDEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MD
Authorized Official - Phone:313-680-3000
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-0660
Mailing Address - Country:US
Mailing Address - Phone:313-680-3000
Mailing Address - Fax:
Practice Address - Street 1:838 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1054
Practice Address - Country:US
Practice Address - Phone:616-374-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPENDING3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid
MIPENDINGMedicaid