Provider Demographics
NPI:1114085388
Name:LARA PHARMACY CORPORATION
Entity Type:Organization
Organization Name:LARA PHARMACY CORPORATION
Other - Org Name:STANFRED DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-767-3737
Mailing Address - Street 1:8031 VINELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3951
Mailing Address - Country:US
Mailing Address - Phone:818-767-3737
Mailing Address - Fax:818-767-4690
Practice Address - Street 1:8031 VINELAND AVENUE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3951
Practice Address - Country:US
Practice Address - Phone:818-767-3737
Practice Address - Fax:818-767-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA3548203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA354820Medicaid
CA1235210001Medicare NSC