Healthcare Provider Details

I. General information

NPI: 1114085388
Provider Name (Legal Business Name): LARA PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 VINELAND AVENUE
SUN VALLEY CA
91352-3951
US

IV. Provider business mailing address

8031 VINELAND AVENUE
SUN VALLEY CA
91352-3951
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-3737
  • Fax: 818-767-4690
Mailing address:
  • Phone: 818-767-3737
  • Fax: 818-767-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA354820
License Number StateCA

VIII. Authorized Official

Name: MRS. ELIZABETH M LARA
Title or Position: PRESIDENT CEO
Credential:
Phone: 818-767-3737