Provider Demographics
NPI:1275818866
Name:LARES, JOANNE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:LARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:LARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOANNE LARES, RPH
Mailing Address - Street 1:15032 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2736
Mailing Address - Country:US
Mailing Address - Phone:954-236-4777
Mailing Address - Fax:
Practice Address - Street 1:15032 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-2736
Practice Address - Country:US
Practice Address - Phone:954-294-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00028639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist