Healthcare Provider Details

I. General information

NPI: 1124616511
Provider Name (Legal Business Name): MR. ZIAD MAZLOUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 N HIGH ST
COLUMBUS OH
43201-1113
US

IV. Provider business mailing address

2160 N HIGH ST
COLUMBUS OH
43201-1113
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2105
  • Fax: 614-294-2610
Mailing address:
  • Phone: 614-294-2105
  • Fax: 614-294-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-23272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: