MEDICARE: LAWRENCE JAY PIZIK 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS16932	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS16932	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1700516853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE JAY PIZIK RPH

Provider Business Mailing Address
First Line	:	3300 NW 91ST WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8521
Country	:	US
Telephone Number	:	954-371-6122
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 CYPRESS RD STE 105
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2361
Country	:	US
Telephone Number	:	954-316-5054
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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