Basic Information
| Provider Information | |||||||||
| NPI: | 1194159459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAZARIK | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2103 N ROME AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336073509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134901426 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2103 N ROME AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336073509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134901426 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS24956 | FL | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 13485 | NV | N | Pharmacy Service Providers | Pharmacist | 183500000X | 37772 | TX | N | Pharmacy Service Providers | Pharmacist | 183500000X | 03318412 | OH | N | Pharmacy Service Providers | Pharmacist |
No ID Information.