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Provider Information for 1487775862


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LINDEN PHARMACY LLC

Other Names:  
Doing Business As: 
ADVANCED SPECIALTY RX WEST

Organization Subpart: NO

NPI: 1487775862
Last Updated: 2016-08-26
Certification Date:

Details

NameValue
NPI1487775862
Enumeration Date2007-04-03
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: BASSAM YOUSSEF RPh
Title: OWNER
Phone: 8102322700
Mailing Address 1676 VIEWPOND DR SE STE 9B
KENTWOOD, MI 49508-4994
United States

Phone: 616-427-3158 | Fax:616-454-1555
 
Primary Practice Address 1676 VIEWPOND DR SE STE 9B
KENTWOOD, MI 49508-4994
United States

Phone: 616-427-3158 | Fax:616-454-1555
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2042616PK
MEDICAIDMI4988141
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336L0003X - Pharmacy - Long Term Care PharmacyMI5301008587