Healthcare Provider Details

I. General information

NPI: 1295918274
Provider Name (Legal Business Name): ISIDRO II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7288 N SHELDON RD STE A
CANTON MI
48187-2150
US

IV. Provider business mailing address

PO BOX 871819
CANTON MI
48187-7519
US

V. Phone/Fax

Practice location:
  • Phone: 734-812-9129
  • Fax: 734-629-1717
Mailing address:
  • Phone: 734-812-9129
  • Fax: 734-629-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008406
License Number StateMI

VIII. Authorized Official

Name: MARIA YOUNG
Title or Position: OWNER, PRES, PIC
Credential: RPH
Phone: 734-812-9129