Provider Demographics
NPI:1770551285
Name:LAZDINS, MARUTA R (CRPH)
Entity type:Individual
Prefix:MRS
First Name:MARUTA
Middle Name:R
Last Name:LAZDINS
Suffix:
Gender:F
Credentials:CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 HODSON PL
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-1522
Mailing Address - Country:US
Mailing Address - Phone:727-595-5431
Mailing Address - Fax:813-774-7814
Practice Address - Street 1:6499 38TH AVE N
Practice Address - Street 2:A-1
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1656
Practice Address - Country:US
Practice Address - Phone:727-344-3902
Practice Address - Fax:727-343-1356
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist