MEDICARE: LARA BERRI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302413134	MI

General Provider Information

NPI Number	:	1215533674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA BERRI

Provider Business Mailing Address
First Line	:	7529 ORCHARD AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7529 ORCHARD AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1311
Country	:	US
Telephone Number	:	313-615-0122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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Directions to “ LARA BERRI ” Practice Location

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