Provider Demographics
NPI:1255962395
Name:BADREDDINE, LOUBNA BAZZI (RPH)
Entity type:Individual
Prefix:
First Name:LOUBNA
Middle Name:BAZZI
Last Name:BADREDDINE
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 1:714 CENTRALIA ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3720
Mailing Address - Country:US
Mailing Address - Phone:313-409-6102
Mailing Address - Fax:
Practice Address - Street 1:15325 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2954
Practice Address - Country:US
Practice Address - Phone:313-582-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist