1114107216 NPI number — LIZZA PHARMACEUTICAL INC

Table of content: (NPI 1114107216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114107216 NPI number — LIZZA PHARMACEUTICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIZZA PHARMACEUTICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAUREL LTC PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114107216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 MORGANTOWN ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-4718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-437-5070
Provider Business Mailing Address Fax Number:
724-437-7808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
173 MORGANTOWN ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-4718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-437-5070
Provider Business Practice Location Address Fax Number:
724-437-7808
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIZZA
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
724-437-5070

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PP481698 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2082220 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102091796001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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