MEDICARE: MS. ELIZABETH LATERZA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI0725400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28RI0725400	OTHER	NJ	STATE LICENSE

General Provider Information

NPI Number	:	1275895583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH LATERZA RPH

Provider Business Mailing Address
First Line	:	37 OAKWOOD AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-6045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 GRAND ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4240
Country	:	US
Telephone Number	:	201-432-5513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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