Provider Demographics
NPI:1164078697
Name:LARA, JESUS JR (RPH)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:LARA
Suffix:JR
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 1:200 W EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2951
Mailing Address - Country:US
Mailing Address - Phone:956-630-2911
Mailing Address - Fax:
Practice Address - Street 1:200 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2951
Practice Address - Country:US
Practice Address - Phone:956-630-2911
Practice Address - Fax:956-686-2713
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist