Provider Demographics
NPI:1134838501
Name:NAZZAL, MONA H (RPH)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:H
Last Name:NAZZAL
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 1:181 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1138
Mailing Address - Country:US
Mailing Address - Phone:313-377-7446
Mailing Address - Fax:
Practice Address - Street 1:181 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1138
Practice Address - Country:US
Practice Address - Phone:313-377-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302413954OtherLICENSE