Provider Demographics
NPI:1285163287
Name:VIZZINA, LAURA (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VIZZINA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SAINT ANNES DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3267
Mailing Address - Country:US
Mailing Address - Phone:205-999-7699
Mailing Address - Fax:
Practice Address - Street 1:630 COLONIAL PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-3111
Practice Address - Country:US
Practice Address - Phone:205-999-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist