MEDICARE: LARA MCINTOSH

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	47975	TX

General Provider Information

NPI Number	:	1568187094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA MCINTOSH

Provider Business Mailing Address
First Line	:	5725 N ELDRIDGE PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-6520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5725 N ELDRIDGE PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-6520
Country	:	US
Telephone Number	:	713-856-1464
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Directions to “ LARA MCINTOSH ” Practice Location

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