Provider Demographics
NPI:1760992325
Name:LAZARE, DENEICIA TASHNELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENEICIA
Middle Name:TASHNELLE
Last Name:LAZARE
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 1:157 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1700
Mailing Address - Country:US
Mailing Address - Phone:347-465-2462
Mailing Address - Fax:
Practice Address - Street 1:9 CITY PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3331
Practice Address - Country:US
Practice Address - Phone:914-821-0013
Practice Address - Fax:914-821-1709
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY063203OtherPHARMACIST LICENSE