Provider Demographics
NPI:1831464361
Name:BLIZNESKY, LODGE (PHARMD BCPS CACP)
Entity Type:Individual
Prefix:DR
First Name:LODGE
Middle Name:
Last Name:BLIZNESKY
Suffix:
Gender:M
Credentials:PHARMD BCPS CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 OLYMPIA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-1365
Mailing Address - Country:US
Mailing Address - Phone:412-716-3794
Mailing Address - Fax:
Practice Address - Street 1:140 OLYMPIA ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15211-1365
Practice Address - Country:US
Practice Address - Phone:412-716-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442730183500000X
PARPI000911183500000X
OHRPH03328896-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist