Healthcare Provider Details

I. General information

NPI: 1114570504
Provider Name (Legal Business Name): ADVANCE CARE RX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12097 CONANT ST
HAMTRAMCK MI
48212-2716
US

IV. Provider business mailing address

12097 CONANT ST
HAMTRAMCK MI
48212-2716
US

V. Phone/Fax

Practice location:
  • Phone: 313-826-1713
  • Fax: 313-826-1714
Mailing address:
  • Phone: 313-826-1713
  • Fax: 313-826-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE MARIE PIZZUTI
Title or Position: OWNER/RPH
Credential:
Phone: 313-826-1713