Provider Demographics
NPI:1619201811
Name:LARA-NEVAREZ, MARICELA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:
Last Name:LARA-NEVAREZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 LAKESHORE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4980
Mailing Address - Country:US
Mailing Address - Phone:972-538-8148
Mailing Address - Fax:866-770-6421
Practice Address - Street 1:1234 LAKESHORE DR STE 200
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4980
Practice Address - Country:US
Practice Address - Phone:972-538-8148
Practice Address - Fax:866-770-6421
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX422761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist