Provider Demographics
NPI:1972631570
Name:LARA, MADELYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S LOOMIS ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4011
Mailing Address - Country:US
Mailing Address - Phone:312-217-2171
Mailing Address - Fax:
Practice Address - Street 1:1657 W ADAMS ST
Practice Address - Street 2:UNION MEDICAL CENTER PHARMACY, 3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3201
Practice Address - Country:US
Practice Address - Phone:312-829-1134
Practice Address - Fax:312-377-7983
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist