Healthcare Provider Details

I. General information

NPI: 1336616176
Provider Name (Legal Business Name): ANGELA AZZOUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47300 PONTIAC TRL
WIXOM MI
48393-2551
US

IV. Provider business mailing address

29805 LILLEY TRL
NOVI MI
48377-1823
US

V. Phone/Fax

Practice location:
  • Phone: 248-960-0352
  • Fax:
Mailing address:
  • Phone: 248-767-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302045673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: