Provider Demographics
NPI:1902622095
Name:ZOTTI, MOUSTAFA (PHARMD)
Entity type:Individual
Prefix:
First Name:MOUSTAFA
Middle Name:
Last Name:ZOTTI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SANDWICH WEST PARKWAY
Mailing Address - Street 2:204
Mailing Address - City:LASALLE
Mailing Address - State:ON
Mailing Address - Zip Code:N9H 0N4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1191 SOUTH BLVD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5453
Practice Address - Country:US
Practice Address - Phone:800-456-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist