MEDICARE: MR. RAYMOND FRANK LAZZARA 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	034807	NY

General Provider Information

NPI Number	:	1548592959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND FRANK LAZZARA RPH

Provider Business Mailing Address
First Line	:	1 DIAMOND CT
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-1604
Country	:	US
Telephone Number	:	732-297-3954
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 BLEECKER ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-2980
Country	:	US
Telephone Number	:	212-807-7566
Fax Number	:

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

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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