=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215550389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE B LANZA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2020
-----------------------------------------------------
Last Update Date | 01/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9217 MAIN ST
-----------------------------------------------------
City | CLARENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14031-1931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-634-7901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 POTTERS RD
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14220-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-289-3485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 067116
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------