Provider Demographics
NPI:1689817975
Name:KAZA, JYOTHI (RPH)
Entity Type:Individual
Prefix:
First Name:JYOTHI
Middle Name:
Last Name:KAZA
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 1:24627 THATCHER DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2367
Mailing Address - Country:US
Mailing Address - Phone:248-946-4273
Mailing Address - Fax:
Practice Address - Street 1:5520 DRAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1259
Practice Address - Country:US
Practice Address - Phone:248-661-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist