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General NPI Number Information
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NPI Number | 1114561933
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Entity Type | Organization
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Legal Business Name | ADVANCED RX HEALTH LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 29866 FORD RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2365
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Country | US
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Telephone | 734-744-7775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23045
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City | DEARBORN
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State | MI
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Zip | 48123-2870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | FOUAD FARDOUS
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Credential |
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Telephone | 734-744-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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