Provider Demographics
NPI:1154081545
Name:ALAZZAWI, LANA
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:ALAZZAWI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 HAWKHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1201
Mailing Address - Country:US
Mailing Address - Phone:916-450-9889
Mailing Address - Fax:
Practice Address - Street 1:4331 ANTELOPE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95843-6022
Practice Address - Country:US
Practice Address - Phone:916-722-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH85538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist