Provider Demographics
NPI:1619578739
Name:LEZARK, ANTONELLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTONELLA
Middle Name:
Last Name:LEZARK
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 1:5851 NW 177TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5127
Mailing Address - Country:US
Mailing Address - Phone:305-558-7490
Mailing Address - Fax:
Practice Address - Street 1:5851 NW 177TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5127
Practice Address - Country:US
Practice Address - Phone:305-558-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist