MEDICARE: ADVANCED RX LLC

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	3336L0003X	Long Term Care Pharmacy	PENDING	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144749425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED RX LLC

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-0660
Country	:	US
Telephone Number	:	313-680-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1054
Country	:	US
Telephone Number	:	616-374-3190
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FADI NASERDEAN
Credential	:	PHARM.D, MD
Telephone Number	:	313-680-3000

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/12/2025

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Directions to “ADVANCED RX LLC ” Practice Location

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