Provider Demographics
NPI:1821816539
Name:BAZZI, MARIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:BAZZI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34569 MIDDLEBORO ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5317
Mailing Address - Country:US
Mailing Address - Phone:313-895-6793
Mailing Address - Fax:
Practice Address - Street 1:10011 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2453
Practice Address - Country:US
Practice Address - Phone:313-340-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS6684183500000X
MI5302415646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist