Healthcare Provider Details

I. General information

NPI: 1902622095
Provider Name (Legal Business Name): MOUSTAFA ZOTTI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 SOUTH BLVD E
ROCHESTER HILLS MI
48307-5453
US

IV. Provider business mailing address

2550 SANDWICH WEST PARKWAY 204
LASALLE ON
N9H 0N4
CA

V. Phone/Fax

Practice location:
  • Phone: 800-456-2112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302415251
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: