Healthcare Provider Details

I. General information

NPI: 1417860552
Provider Name (Legal Business Name): SAMUEL JACOB LAZARUS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST
OLEAN NY
14760-1513
US

IV. Provider business mailing address

57 PARK ST APT 3
SPRINGVILLE NY
14141-1173
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-2600
  • Fax:
Mailing address:
  • Phone: 585-905-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: