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General NPI Number Information
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NPI Number | 1164113544
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Entity Type | Individual
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Provider Name | KELLY LYNN LASCAK
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Gender | Female
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 9141 RIDGE RD
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City | GIRARD
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State | PA
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Zip | 16417-9645
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Country | US
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Telephone | 814-774-8880
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Fax | 814-774-1169
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Provider Business Mailing Address
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Address Line | 283 HARBOR ST APT 3
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City | CONNEAUT
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State | OH
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Zip | 44030-1980
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Country | US
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Telephone | 941-276-2330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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