Healthcare Provider Details

I. General information

NPI: 1881840098
Provider Name (Legal Business Name): LINDA GAYNELL LAZARZ PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 WILLOW CREEK RD
PRESCOTT AZ
86301-1492
US

IV. Provider business mailing address

1301 N KETTLE HILL RD
PRESCOTT VALLEY AZ
86314-1415
US

V. Phone/Fax

Practice location:
  • Phone: 928-227-9965
  • Fax:
Mailing address:
  • Phone: 928-772-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15252
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: