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ADVANCED RX LLC NPI 1275641649


NPI Information

NPI: 1275641649
Provider Name: ADVANCED RX LLC

Doing Business As: NEW WALKER'S PROFESSIONAL PHARMACY LTC

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 23D0979533

Address:
838 4TH AVENUE
LAKE ODESSA, MI
ZIP 48849
Phone: (616) 374-3190
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ADVANCED RX LLC is a community/retail pharmacy pharmacy in Lake Odessa, MI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. ADVANCED RX LLC NPI is 1275641649. The provider is registered as an organization entity type.
The provider Is Doing Business As New Walker's Professional Pharmacy Ltc.

The provider's business location address is:

838 4TH AVENUE
LAKE ODESSA, MI
ZIP 48849
Phone: (616) 374-3190
Fax: (616) 374-0921

The provider's authorized official is Fadi Naserdean .
The authorized official title is President and has the following contact phone number (313) 680-3000.

The CLIA number assigned to this NPI record is 23D0979533 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/27/2006 and was last updated on 8/16/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336L0003XPharmacyLong Term Care PharmacyNo
33336C0003XPharmacyCommunity/Retail Pharmacy5301005445MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12175188OTHERPK
2021935001MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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