Provider Demographics
NPI:1881840098
Name:LAZARZ, LINDA GAYNELL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYNELL
Last Name:LAZARZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N KETTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1415
Mailing Address - Country:US
Mailing Address - Phone:928-772-3362
Mailing Address - Fax:
Practice Address - Street 1:1310 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1492
Practice Address - Country:US
Practice Address - Phone:928-227-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist