Healthcare Provider Details

I. General information

NPI: 1174797658
Provider Name (Legal Business Name): ELIZABETH MARIE MAZZARA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 26 MILE RD
WASHINGTON MI
48094-3820
US

IV. Provider business mailing address

7887 26 MILE RD
WASHINGTON MI
48094-3820
US

V. Phone/Fax

Practice location:
  • Phone: 586-677-3438
  • Fax: 586-677-5293
Mailing address:
  • Phone: 586-677-3438
  • Fax: 586-677-5293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302410822
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: