Healthcare Provider Details

I. General information

NPI: 1831767243
Provider Name (Legal Business Name): LIZA BASMAJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 06/12/2021
Certification Date: 06/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37355 8 MILE RD
LIVONIA MI
48152-1148
US

IV. Provider business mailing address

20774 WAKEDON ST
SOUTHFIELD MI
48033-3642
US

V. Phone/Fax

Practice location:
  • Phone: 248-474-8657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303004479
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: