Provider Demographics
NPI:1376684233
Name:RIZZO'S PHARMACY
Entity Type:Organization
Organization Name:RIZZO'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-473-6141
Mailing Address - Street 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2204
Mailing Address - Country:US
Mailing Address - Phone:201-473-6141
Mailing Address - Fax:201-473-7359
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2204
Practice Address - Country:US
Practice Address - Phone:201-473-6141
Practice Address - Fax:201-473-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS001229003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4266609Medicaid
NJ4266609Medicaid