Provider Demographics
NPI:1144411919
Name:LOMBARDI, JOHN EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1601
Mailing Address - Country:US
Mailing Address - Phone:954-974-6702
Mailing Address - Fax:
Practice Address - Street 1:3600 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6616
Practice Address - Country:US
Practice Address - Phone:800-526-1490
Practice Address - Fax:800-526-1491
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21762183500000X
MAMA19499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA19499OtherMA STATE LICENSE
FLPS21762OtherFL STATE LICENSE