Healthcare Provider Details

I. General information

NPI: 1801041413
Provider Name (Legal Business Name): STEVEN A LAZZARA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 AVENUE N
BROOKLYN NY
11234-4129
US

IV. Provider business mailing address

404 ATLANTIS AVE
MANAHAWKIN NJ
08050-2060
US

V. Phone/Fax

Practice location:
  • Phone: 718-209-2222
  • Fax:
Mailing address:
  • Phone: 609-978-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038804
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number038804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: