MEDICARE: SUSAN M TAZZI

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
1	183500000X	Pharmacist	5302024175	MI

General Provider Information

NPI Number	:	1689207961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M TAZZI

Provider Business Mailing Address
First Line	:	67181 S MAIN ST
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-1939
Country	:	US
Telephone Number	:	586-727-2781
Fax Number	:

Provider Business Practice Location Address
First Line	:	67181 S MAIN ST
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-1939
Country	:	US
Telephone Number	:	586-727-2781
Fax Number	:	586-727-3558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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Directions to “ SUSAN M TAZZI ” Practice Location

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