Provider Demographics
NPI:1629357645
Name:ADVANCE CARE PHARMACY PC
Entity Type:Organization
Organization Name:ADVANCE CARE PHARMACY PC
Other - Org Name:ADVANCE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULGHNI
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DR OF PHARMACY
Authorized Official - Phone:313-574-2119
Mailing Address - Street 1:24822 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1147
Mailing Address - Country:US
Mailing Address - Phone:248-545-5515
Mailing Address - Fax:248-545-5590
Practice Address - Street 1:24822 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1147
Practice Address - Country:US
Practice Address - Phone:248-545-5515
Practice Address - Fax:248-545-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010096493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131525OtherPK