Provider Demographics
NPI:1508131095
Name:MEZZA, DOROTHY ANGELA (RPH)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ANGELA
Last Name:MEZZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44831 LARKSPUR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1397
Mailing Address - Country:US
Mailing Address - Phone:586-899-3110
Mailing Address - Fax:
Practice Address - Street 1:3000 COMMERCE XING
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3082
Practice Address - Country:US
Practice Address - Phone:248-529-2305
Practice Address - Fax:248-529-2323
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist