Provider Demographics
NPI:1376174334
Name:BAZZI, MOHAMED A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:BAZZI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18901 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1402
Mailing Address - Country:US
Mailing Address - Phone:313-387-4120
Mailing Address - Fax:
Practice Address - Street 1:18901 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1402
Practice Address - Country:US
Practice Address - Phone:313-387-4120
Practice Address - Fax:313-387-4110
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist