Healthcare Provider Details

I. General information

NPI: 1073638862
Provider Name (Legal Business Name): JAY B LAZAR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 N BROADWAY ST
CHICAGO IL
60660-2500
US

IV. Provider business mailing address

950 W HURON ST #306
CHICAGO IL
60622-6675
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-1259
  • Fax: 773-769-3440
Mailing address:
  • Phone: 312-666-3447
  • Fax: 773-769-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: