Provider Demographics
NPI:1164544862
Name:LAZENBY, JOHN THOMAS III (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:LAZENBY
Suffix:III
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:998 WILLIAMS MILL RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4431
Mailing Address - Country:US
Mailing Address - Phone:770-457-6237
Mailing Address - Fax:770-451-8018
Practice Address - Street 1:3807 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4911
Practice Address - Country:US
Practice Address - Phone:770-457-6236
Practice Address - Fax:770-451-8018
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist