=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972055903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DHARA LARI PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2016
-----------------------------------------------------
Last Update Date | 10/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 3RD AVE W UNIT 341
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-4183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-301-4117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 3RD AVE W UNIT 341
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-4183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-301-4117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH60665401
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------