Healthcare Provider Details

I. General information

NPI: 1629296884
Provider Name (Legal Business Name): WEJDAN J AZZOU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31320 FIVE MILE RD
LIVONIA MI
48154-3680
US

IV. Provider business mailing address

4130 E NEWLAND DR
WEST BLOOMFIELD MI
48323-3054
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-3430
  • Fax: 734-427-1293
Mailing address:
  • Phone: 248-737-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026811
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302026811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: