Healthcare Provider Details

I. General information

NPI: 1295987253
Provider Name (Legal Business Name): ADVANCED SPECIALTY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 W BRISTOL RD STE 350
FLINT MI
48507-3111
US

IV. Provider business mailing address

4488 W BRISTOL RD STE 350
FLINT MI
48507-3111
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-2700
  • Fax: 888-246-0436
Mailing address:
  • Phone: 810-232-2700
  • Fax: 888-246-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301008902
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BASSAM YOUSSEF
Title or Position: OWNER
Credential:
Phone: 810-230-8300