Provider Demographics
NPI:1700119484
Name:ANDERSON, JENNIFER LAZO (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAZO
Last Name:ANDERSON
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 1:2000 FRONTIS PLAZA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2470
Mailing Address - Fax:704-338-6358
Practice Address - Street 1:2000 FRONTIS PLAZA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5616
Practice Address - Country:US
Practice Address - Phone:336-277-2470
Practice Address - Fax:704-338-6358
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist