Provider Demographics
NPI:1396111308
Name:LARA, PEDRO J (RPH)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:LARA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 AVE RAFAEL CORDERO
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5000
Mailing Address - Country:US
Mailing Address - Phone:787-286-8463
Mailing Address - Fax:787-286-8731
Practice Address - Street 1:301 AVE RAFAEL CORDERO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5000
Practice Address - Country:US
Practice Address - Phone:787-286-8463
Practice Address - Fax:787-286-8731
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist