Provider Demographics
NPI:1538475066
Name:BOOTH, LARA DAESCHER (RPH)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:DAESCHER
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 S EUFAULA AVE
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-2701
Mailing Address - Country:US
Mailing Address - Phone:334-687-8781
Mailing Address - Fax:334-687-8725
Practice Address - Street 1:1037 S EUFAULA AVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2701
Practice Address - Country:US
Practice Address - Phone:334-687-8781
Practice Address - Fax:334-687-8725
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15207183500000X
NC12573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist