Provider Demographics
NPI:1164731089
Name:POLIZZI, VINCENT RICHARD II (RPH)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:RICHARD
Last Name:POLIZZI
Suffix:II
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 1:4912 MAYEAUX ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1129
Mailing Address - Country:US
Mailing Address - Phone:504-309-6482
Mailing Address - Fax:
Practice Address - Street 1:909 DAVID DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-5134
Practice Address - Country:US
Practice Address - Phone:504-818-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist