Provider Demographics
NPI:1699411769
Name:LARE, REBECCA ERIN (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ERIN
Last Name:LARE
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 1:321 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1122
Mailing Address - Country:US
Mailing Address - Phone:419-203-1131
Mailing Address - Fax:
Practice Address - Street 1:940 ELIDA AVE
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-1784
Practice Address - Country:US
Practice Address - Phone:419-695-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist