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Provider Information for 1295987253


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ADVANCED SPECIALTY RX LLC

Other Names:  
Doing Business As: 
ADVANCED SPECIALTY RX

Organization Subpart: NO

NPI: 1295987253
Last Updated: 2021-10-12
Certification Date: 2021-10-12

Details

NameValue
NPI1295987253
Enumeration Date2008-10-21
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: BASSAM YOUSSEF
Title: Owner
Phone: 8102308300
Mailing Address 4488 W BRISTOL RD STE 350
FLINT, MI 48507-3111
United States

Phone: 810-232-2700 | Fax:888-246-0436
 
Primary Practice Address 4488 W BRISTOL RD STE 350
FLINT, MI 48507-3111
United States

Phone: 810-232-2700 | Fax:888-246-0436
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2125139PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336S0011X - Pharmacy - Specialty Pharmacy
No 3336C0004X - Pharmacy - Compounding Pharmacy
No 3336M0003X - Pharmacy - Managed Care Organization Pharmacy
Yes 3336L0003X - Pharmacy - Long Term Care PharmacyMI5301008902