Provider Demographics
NPI:1932652161
Name:BRODIE, ALIA (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:ALIA
Middle Name:
Last Name:BRODIE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 N CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3594
Mailing Address - Country:US
Mailing Address - Phone:734-755-9245
Mailing Address - Fax:734-384-8065
Practice Address - Street 1:1700 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9204
Practice Address - Country:US
Practice Address - Phone:734-384-8033
Practice Address - Fax:734-384-8065
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020405303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302040530OtherPHARMACIST LICSENCE