Provider Demographics
NPI:1477890523
Name:HOLCOMB, LARA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:ANN
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 HIGHWAY 20 W
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7205
Mailing Address - Country:US
Mailing Address - Phone:770-898-6731
Mailing Address - Fax:770-898-6861
Practice Address - Street 1:2158 HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7205
Practice Address - Country:US
Practice Address - Phone:770-898-6731
Practice Address - Fax:770-898-6861
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist