Provider Demographics
NPI:1457617508
Name:MOUZAKIS, MARK MITCHELL (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MITCHELL
Last Name:MOUZAKIS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 S COUNTY ROAD 489
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MI
Mailing Address - Zip Code:49756-8155
Mailing Address - Country:US
Mailing Address - Phone:989-786-2239
Mailing Address - Fax:989-786-9150
Practice Address - Street 1:2855 S COUNTY ROAD 489
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MI
Practice Address - Zip Code:49756-8155
Practice Address - Country:US
Practice Address - Phone:989-786-2239
Practice Address - Fax:989-786-9150
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist