Provider Demographics
NPI:1366747271
Name:LAZNIK, JEFFREY J (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:LAZNIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 DOOKS CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6895
Mailing Address - Country:US
Mailing Address - Phone:843-267-6859
Mailing Address - Fax:843-234-0898
Practice Address - Street 1:3011 DOOKS CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6895
Practice Address - Country:US
Practice Address - Phone:843-267-6859
Practice Address - Fax:843-234-0898
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10281183500000X
DE0002486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist