Provider Demographics
NPI:1093328445
Name:LAZEVNICK, RACHEL ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ROSE
Last Name:LAZEVNICK
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 1:59 PARSONAGE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2155
Mailing Address - Country:US
Mailing Address - Phone:570-606-7192
Mailing Address - Fax:
Practice Address - Street 1:57 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1915
Practice Address - Country:US
Practice Address - Phone:570-602-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI013891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist