Provider Demographics
NPI:1376966283
Name:HARA, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 E PALOMAR ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6974
Mailing Address - Country:US
Mailing Address - Phone:619-397-0466
Mailing Address - Fax:619-397-0926
Practice Address - Street 1:659 E PALOMAR ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6974
Practice Address - Country:US
Practice Address - Phone:619-397-0466
Practice Address - Fax:619-397-0926
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58065183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist