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General NPI Number Information
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NPI Number | 1295918274
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Entity Type | Organization
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Legal Business Name | ISIDRO II INC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 7288 N SHELDON RD STE A
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City | CANTON
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State | MI
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Zip | 48187-2150
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Country | US
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Telephone | 734-812-9129
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Fax | 734-629-1717
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Provider Business Mailing Address
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Address Line | PO BOX 871819
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City | CANTON
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State | MI
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Zip | 48187-7519
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Country | US
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Telephone | 734-812-9129
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Fax | 734-629-1717
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Authorized Official
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Title or Position | OWNER, PRES, PIC
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Name | MARIA YOUNG
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Credential | RPH
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Telephone | 734-812-9129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008406
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License Number State | MI
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