Provider Demographics
NPI:1548414253
Name:DENTON AYRES, LARA (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:DENTON AYRES
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:DR
Other - First Name:LARA
Other - Middle Name:JILL
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, MBA
Mailing Address - Street 1:1200 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5294
Mailing Address - Country:US
Mailing Address - Phone:423-753-9730
Mailing Address - Fax:
Practice Address - Street 1:1200 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5294
Practice Address - Country:US
Practice Address - Phone:423-753-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist