Provider Demographics
NPI:1891806394
Name:ADVANCED PHARMACY & NUTRITION CENTER
Entity Type:Organization
Organization Name:ADVANCED PHARMACY & NUTRITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-688-3090
Mailing Address - Street 1:3960 HURON ST
Mailing Address - Street 2:PO BOX 319
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-6122
Mailing Address - Country:US
Mailing Address - Phone:810-688-3090
Mailing Address - Fax:810-688-3791
Practice Address - Street 1:3960 HURON ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-6122
Practice Address - Country:US
Practice Address - Phone:810-688-3090
Practice Address - Fax:810-688-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL7105123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3521208Medicaid
MI1274430001Medicare ID - Type Unspecified