Healthcare Provider Details

I. General information

NPI: 1184173379
Provider Name (Legal Business Name): CASEY LAZZARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HARRISON AVE
BUTTE MT
59701-3544
US

IV. Provider business mailing address

3301 BURLINGTON ST
BUTTE MT
59701-4415
US

V. Phone/Fax

Practice location:
  • Phone: 406-494-1075
  • Fax: 406-494-1338
Mailing address:
  • Phone: 406-491-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39712
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: