Provider Demographics
NPI:1982175980
Name:AZIZ, YOUHANNA (RPH / PHARMD)
Entity Type:Individual
Prefix:
First Name:YOUHANNA
Middle Name:
Last Name:AZIZ
Suffix:
Gender:M
Credentials:RPH / PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 CATO LN APT B1
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-2071
Mailing Address - Country:US
Mailing Address - Phone:857-225-7622
Mailing Address - Fax:
Practice Address - Street 1:102 N CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1308
Practice Address - Country:US
Practice Address - Phone:269-651-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302047139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist