Healthcare Provider Details

I. General information

NPI: 1760992325
Provider Name (Legal Business Name): DENEICIA TASHNELLE LAZARE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CITY PL
WHITE PLAINS NY
10601-3331
US

IV. Provider business mailing address

157 HILLSIDE AVE
STATEN ISLAND NY
10304-1700
US

V. Phone/Fax

Practice location:
  • Phone: 914-821-0013
  • Fax: 914-821-1709
Mailing address:
  • Phone: 347-465-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: