Individual ProviderJose Gustavo LazoPharmacistPharmacy Service ProvidersPractice Address521 Parnassus Ave Room C-152, B- 0622, San Francisco, CA 94143(973) 986-3098PECOS EnrollmentBased on the most recent information from CMS, provider Jose Gustavo Lazo does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1124622030Provider TypeIndividualFull NameLazo, Jose GustavoGenderMaleSole ProprietorYesEnumeration Date11/23/2020Last Updated12/20/2022Contact InformationPractice LocationPractice Address521 Parnassus Ave Room C-152, B- 0622, San Francisco, CA 94143Phone(973) 986-3098FaxUnlisted FaxMailing LocationMailing Address521 Parnassus Ave Room C-152, Box 0622, San Francisco, CA 94143Phone(973) 986-3098FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense81272CaliforniaCode333600000XDescriptionPharmacySuppliersLicense28RJ07964New Jersey