Healthcare Provider Details

I. General information

NPI: 1114107216
Provider Name (Legal Business Name): LIZZA PHARMACEUTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MCCLELLANDTOWN ROAD
UNIONTOWN PA
15401
US

IV. Provider business mailing address

40 WIGHT AVE STE 100
COCKEYSVILLE MD
21030-2148
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-5070
  • Fax: 724-437-7808
Mailing address:
  • Phone: 667-408-7767
  • Fax: 724-437-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP481698
License Number StatePA

VIII. Authorized Official

Name: DANIEL MANDOLI
Title or Position: COO
Credential:
Phone: 314-494-7493