Provider Demographics
NPI:1235231721
Name:MAZZOLI, GEORGANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GEORGANN
Middle Name:
Last Name:MAZZOLI
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 1:6361 NICHOLAS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12301 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1002
Practice Address - Country:US
Practice Address - Phone:216-265-4465
Practice Address - Fax:216-265-4415
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-238671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy