Provider Demographics
NPI:1679816839
Name:MAZZA, DEBRA (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:MAZZA
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 1:316 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5262
Mailing Address - Country:US
Mailing Address - Phone:702-321-4411
Mailing Address - Fax:
Practice Address - Street 1:316 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5262
Practice Address - Country:US
Practice Address - Phone:702-321-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist