Provider Demographics
NPI:1255661484
Name:LA SHELL, DAREN J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:J
Last Name:LA SHELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E STETSON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7139
Mailing Address - Country:US
Mailing Address - Phone:951-766-1618
Mailing Address - Fax:951-766-2849
Practice Address - Street 1:110 E STETSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-766-1618
Practice Address - Fax:951-766-2849
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist