Organization
KOZ-LAZ INCORPORATED
Active
Other names
ARCHER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACK LAZZARA RPH (PRESIDENT AND OWNER)
(773) 586-1134
Entity
Organization
Contact information
Practice address
6456 W ARCHER AVE, CHICAGO, IL 60638-2537
(773) 586-1134
(773) 586-1151
Mailing address
6456 W ARCHER AVE, CHICAGO, IL 60638-2537
(773) 586-1134
(773) 586-1151
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054013977
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1469368
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/31/2006
Last updated
10/13/2009
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