Healthcare Provider Details

I. General information

NPI: 1982175980
Provider Name (Legal Business Name): YOUHANNA AZIZ RPH / PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N CENTERVILLE RD
STURGIS MI
49091-1308
US

IV. Provider business mailing address

1021 CATO LN APT B1
STURGIS MI
49091-2071
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-7818
  • Fax:
Mailing address:
  • Phone: 857-225-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302047139
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: