NPIMap

Organization Active NPI

Advanced RX LLC

Doing business as New Walker's Professional Pharmacy LTC

  • Community/Retail Pharmacy
  • Lake Odessa, MI
National Provider Identifier
1275641649
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301005445 Issued in MI
Legal business name
ADVANCED RX LLC
Doing business as
New Walker's Professional Pharmacy LTC
Practice address
838 4TH Avenue
Lake Odessa, MI 48849
Phone
(616) 374-3190
Fax
(616) 374-0921
NPI assigned
Aug 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Fadi Naserdean, PHARMD, MDNPI 1841392743
Title
President
Phone
(313) 680-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301005445 MI Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

838 4TH Avenue
Lake Odessa, MI 48849

Mailing address

P.O. Box 660
Dearborn Heights, MI 48127
Phone (616) 374-3190

Other identifiers 2

IdentifierTypeStateIssuer
021935001MedicaidMI
2175188OtherPK

Other names 1

  • New Walker's Professional Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Advanced RX LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

838 4th Ave
Lake Odessa, MI 48849
Phone (616) 374-3190

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1275641649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 660",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "48127",
            "telephone_number": "616-374-3190",
            "fax_number": "616-374-0921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "838 4TH AVENUE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "48849",
            "telephone_number": "616-374-3190",
            "fax_number": "616-374-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "NASERDEAN",
        "authorized_official_first_name": "FADI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-680-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD, MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301005445",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021935001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2175188",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Walker's Professional Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Odessa, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.