Provider Demographics
NPI:1376993501
Name:ZAKARIA, G M (RPH)
Entity Type:Individual
Prefix:
First Name:G
Middle Name:M
Last Name:ZAKARIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54770 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1706
Mailing Address - Country:US
Mailing Address - Phone:586-330-4900
Mailing Address - Fax:586-232-5959
Practice Address - Street 1:54770 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-1706
Practice Address - Country:US
Practice Address - Phone:586-330-4900
Practice Address - Fax:586-232-5959
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302031695OtherPHARMACIST LICENSE