Provider Demographics
NPI:1548592959
Name:LAZZARA, RAYMOND FRANK (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:FRANK
Last Name:LAZZARA
Suffix:
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 1:1 DIAMOND CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1604
Mailing Address - Country:US
Mailing Address - Phone:732-297-3954
Mailing Address - Fax:
Practice Address - Street 1:346 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2980
Practice Address - Country:US
Practice Address - Phone:212-807-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist