Healthcare Provider Details

I. General information

NPI: 1649817453
Provider Name (Legal Business Name): ANGELA DAWN ZUKOWSKI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 N DIXIE HWY
MONROE MI
48162-4489
US

IV. Provider business mailing address

5119 OAKHAVEN LN
MONROE MI
48161-4564
US

V. Phone/Fax

Practice location:
  • Phone: 734-289-6310
  • Fax: 734-289-6312
Mailing address:
  • Phone: 734-652-9751
  • Fax: 734-289-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315107100
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5315107100
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: