Provider Demographics
NPI:1972785111
Name:ZDARSKY, LISA M (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ZDARSKY
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 1:621 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5359
Mailing Address - Country:US
Mailing Address - Phone:716-743-8091
Mailing Address - Fax:
Practice Address - Street 1:1070 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3007
Practice Address - Country:US
Practice Address - Phone:716-894-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist