Healthcare Provider Details

I. General information

NPI: 1528246170
Provider Name (Legal Business Name): LARA CONNELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE POLYCLINIC 1145 BROADWAY
SEATTLE WA
98122
US

IV. Provider business mailing address

360 HAYES ST
SEATTLE WA
98109-2816
US

V. Phone/Fax

Practice location:
  • Phone: 206-669-7132
  • Fax:
Mailing address:
  • Phone: 206-669-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00060834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: