Provider Demographics
NPI:1265544100
Name:KOZ-LAZ INCORPORATED
Entity type:Organization
Organization Name:KOZ-LAZ INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-586-1134
Mailing Address - Street 1:6456 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2537
Mailing Address - Country:US
Mailing Address - Phone:773-586-1134
Mailing Address - Fax:773-586-1151
Practice Address - Street 1:6456 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2537
Practice Address - Country:US
Practice Address - Phone:773-586-1134
Practice Address - Fax:773-586-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540139773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1469368OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1469368OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1469368OtherNCPDP PROVIDER IDENTIFICATION NUMBER