Healthcare Provider Details

I. General information

NPI: 1912055575
Provider Name (Legal Business Name): AYZA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7627 WOODBINE RD
WOODBINE MD
21797-8939
US

IV. Provider business mailing address

PO BOX 256
WOODBINE MD
21797-0256
US

V. Phone/Fax

Practice location:
  • Phone: 410-549-1900
  • Fax: 410-549-3776
Mailing address:
  • Phone: 410-549-1900
  • Fax: 410-549-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP04737
License Number StateMD

VIII. Authorized Official

Name: ZUBAIR AZAM
Title or Position: OWNER
Credential:
Phone: 410-549-1900