Provider Demographics
NPI:1376833202
Name:LAZZARO, JANELLE (RPH)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:LAZZARO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SUCKER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-2917
Mailing Address - Country:US
Mailing Address - Phone:860-738-9256
Mailing Address - Fax:
Practice Address - Street 1:104 SUCKER BROOK RD
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-2917
Practice Address - Country:US
Practice Address - Phone:860-738-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7735183500000X
VT0330067449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist