Provider Demographics
NPI:1861121576
Name:ISIDRO II, INC
Entity type:Organization
Organization Name:ISIDRO II, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:734-812-9129
Mailing Address - Street 1:PO BOX 871819
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-7519
Mailing Address - Country:US
Mailing Address - Phone:734-812-9129
Mailing Address - Fax:734-629-1717
Practice Address - Street 1:7288 N SHELDON RD STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2150
Practice Address - Country:US
Practice Address - Phone:734-812-9129
Practice Address - Fax:734-629-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301012844OtherPHARMACY LICENSE
23D1083577OtherCLIA