Provider Demographics
NPI:1063774651
Name:MCCREARY, LAUREN ROEMER (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ROEMER
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:RACHEL
Other - Last Name:ROEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1225 KENTUCKY GREENS WAY
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9351
Mailing Address - Country:US
Mailing Address - Phone:209-483-3255
Mailing Address - Fax:
Practice Address - Street 1:1011 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5134
Practice Address - Country:US
Practice Address - Phone:209-483-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070718183500000X
CA61411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist