Provider Demographics
NPI:1679166672
Name:KAZBOUR, ROLA (RPHD)
Entity Type:Individual
Prefix:
First Name:ROLA
Middle Name:
Last Name:KAZBOUR
Suffix:
Gender:F
Credentials:RPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25901 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1108
Mailing Address - Country:US
Mailing Address - Phone:248-543-7848
Mailing Address - Fax:248-543-7849
Practice Address - Street 1:25901 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1108
Practice Address - Country:US
Practice Address - Phone:248-543-7848
Practice Address - Fax:248-543-7849
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist