Healthcare Provider Details

I. General information

NPI: 1508977885
Provider Name (Legal Business Name): MATTHEW THOMAS MROOZIAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST # 118-CP
DETROIT MI
48201-1916
US

IV. Provider business mailing address

2308 22ND ST
WYANDOTTE MI
48192-4146
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-4607
  • Fax:
Mailing address:
  • Phone: 734-284-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302027879
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: