Provider Demographics
NPI:1083943336
Name:LAZARCZYK, AMY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:LAZARCZYK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 BACKUS RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9581
Mailing Address - Country:US
Mailing Address - Phone:716-450-1628
Mailing Address - Fax:
Practice Address - Street 1:214 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NY
Practice Address - Zip Code:14136-1339
Practice Address - Country:US
Practice Address - Phone:716-934-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053475-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist