Provider Demographics
NPI:1710268552
Name:BAZZI-LANG, HALA J (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:HALA
Middle Name:J
Last Name:BAZZI-LANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46325 W 12 MILE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2458
Mailing Address - Country:US
Mailing Address - Phone:248-267-3004
Mailing Address - Fax:248-267-3005
Practice Address - Street 1:46325 W 12 MILE RD STE 150
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2458
Practice Address - Country:US
Practice Address - Phone:248-267-3004
Practice Address - Fax:248-267-3005
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist