Provider Demographics
NPI:1538503347
Name:SANTOS, LARA SHARMAINE (CPHT)
Entity Type:Individual
Prefix:
First Name:LARA SHARMAINE
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 NE 177TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5256
Mailing Address - Country:US
Mailing Address - Phone:347-484-3055
Mailing Address - Fax:
Practice Address - Street 1:1562 NE 177TH ST APT 210
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5256
Practice Address - Country:US
Practice Address - Phone:347-484-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60335367183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician