Healthcare Provider Details

I. General information

NPI: 1174893366
Provider Name (Legal Business Name): NICOLE LAZOR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N WASHINGTON ST
BALTIMORE MD
21205-1258
US

IV. Provider business mailing address

313 GORDON AVE
SEVERNA PARK MD
21146-4309
US

V. Phone/Fax

Practice location:
  • Phone: 410-522-5639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19182
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: