Provider Demographics
NPI:1952499329
Name:MOUZOON, ARASTEH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ARASTEH
Middle Name:
Last Name:MOUZOON
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 1:735 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5856
Mailing Address - Country:US
Mailing Address - Phone:800-456-2112
Mailing Address - Fax:248-358-9335
Practice Address - Street 1:735 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5856
Practice Address - Country:US
Practice Address - Phone:800-456-2112
Practice Address - Fax:248-358-9335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302032198OtherPHARMACY LICENCE NUMBER