Healthcare Provider Details

I. General information

NPI: 1093827099
Provider Name (Legal Business Name): ADVANCED PHARMACY PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 SCHAEFER RD
DEARBORN MI
48126-2298
US

IV. Provider business mailing address

5728 SCHAEFER RD
DEARBORN MI
48126-2298
US

V. Phone/Fax

Practice location:
  • Phone: 313-624-3016
  • Fax: 313-582-6717
Mailing address:
  • Phone: 313-624-3016
  • Fax: 313-582-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301007103
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FADI NASERDEAN
Title or Position: PRESIDENT
Credential:
Phone: 313-624-3016