MEDICARE: ADVICARE PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301010163	MI

General Provider Information

NPI Number	:	1033545074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVICARE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1535 HIGHWOOD E
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-1234
Country	:	US
Telephone Number	:	248-344-0877
Fax Number	:	248-344-0833

Provider Business Practice Location Address
First Line	:	1531 HIGHWOOD E
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-1234
Country	:	US
Telephone Number	:	248-344-0877
Fax Number	:	248-344-0833

Authorized Official
Title or Position	:	PHARMACY ADMINISTRATOR
Name	:	MRS. BRENDA KARIN HENSLEY
Credential	:
Telephone Number	:	248-344-0877

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	05/01/2024

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