Provider Demographics
NPI:1124575345
Name:VICAREL, LAINE ALEXA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:ALEXA
Last Name:VICAREL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3990
Mailing Address - Country:US
Mailing Address - Phone:419-996-5640
Mailing Address - Fax:419-996-5424
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 450
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-996-5640
Practice Address - Fax:419-996-5424
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334838-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist