1396948832 NPI number — ALEXY E LARA RPH, PHARMD

Table of content: ALEXY E LARA RPH, PHARMD (NPI 1396948832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396948832 NPI number — ALEXY E LARA RPH, PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARA
Provider First Name:
ALEXY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH, PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396948832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3532 COND THE RESIDENCES
Provider Second Line Business Mailing Address:
AVE SUR APT 1713
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00987-5044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-365-1706
Provider Business Mailing Address Fax Number:
787-752-1926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 4908
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00726-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-286-6032
Provider Business Practice Location Address Fax Number:
787-653-2852
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  4959 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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