Healthcare Provider Details

I. General information

NPI: 1295690394
Provider Name (Legal Business Name): ISRAA BAZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S MAIN ST
BROOKLYN MI
49230-9368
US

IV. Provider business mailing address

5250 ORCHARD AVE
DEARBORN MI
48126-4620
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-2115
  • Fax:
Mailing address:
  • Phone: 313-404-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418212
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: