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NPI Code Detail

MEDICARE: MRS. ELIZABETH MARIE MAZZARA RPH

MEDICARE: MRS. ELIZABETH MARIE MAZZARA RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302410822MI

General Provider Information

NPI Number : 1174797658
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH MARIE MAZZARA RPH
Provider Business Mailing Address
First Line : 7887 26 MILE RD
Second Line :
City : WASHINGTON
State : MI
Zip : 48094-3820
Country : US
Telephone Number : 586-677-3438
Fax Number : 586-677-5293
Provider Business Practice Location Address
First Line : 7887 26 MILE RD
Second Line :
City : WASHINGTON
State : MI
Zip : 48094-3820
Country : US
Telephone Number : 586-677-3438
Fax Number : 586-677-5293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2008
Last Update Date : 04/16/2008

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