Provider Demographics
NPI:1558089177
Name:LIZZA, WALTER JOHN
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JOHN
Last Name:LIZZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MORGANTOWN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4718
Mailing Address - Country:US
Mailing Address - Phone:724-437-7801
Mailing Address - Fax:724-437-7808
Practice Address - Street 1:173 MORGANTOWN ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4718
Practice Address - Country:US
Practice Address - Phone:724-437-7801
Practice Address - Fax:724-437-7808
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036816L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist