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General NPI Number Information
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NPI Number | 1164296497
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Entity Type | Individual
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Provider Name | ZANA ILIESKI
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Gender | Female
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 108 W HIGHLAND RD
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City | HOWELL
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State | MI
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Zip | 48843-1159
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Country | US
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Telephone | 517-552-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 6609 HIGHVIEW ST
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City | DEARBORN HTS
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State | MI
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Zip | 48127-2159
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Country | US
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Telephone | 313-903-2965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 5302415167
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License Number State | MI
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