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NPI Code Detail

MEDICARE: DR. JONATHAN LACRO PHARM.D.

MEDICARE: DR. JONATHAN LACRO PHARM.D.
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
11835P1300XPsychiatric Pharmacist43909CA

General Provider Information

NPI Number : 1932108131
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN LACRO PHARM.D.
Provider Business Mailing Address
First Line : 3350 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3350 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0002
Country : US
Telephone Number : 858-642-1263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/08/2007

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