Provider Demographics
NPI:1245996594
Name:DUSEK, LARA ELIZABETH
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:ELIZABETH
Last Name:DUSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 E SPRING ST APT A
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2366
Mailing Address - Country:US
Mailing Address - Phone:703-731-6104
Mailing Address - Fax:
Practice Address - Street 1:13 E SPRING ST APT A
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2366
Practice Address - Country:US
Practice Address - Phone:703-731-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist