Provider Demographics
NPI:1336749332
Name:KOHN, LARA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:LYNN
Last Name:KOHN
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:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:TX
Mailing Address - Zip Code:76527-0806
Mailing Address - Country:US
Mailing Address - Phone:512-294-6533
Mailing Address - Fax:
Practice Address - Street 1:2720 E BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2584
Practice Address - Country:US
Practice Address - Phone:254-542-7697
Practice Address - Fax:254-542-7710
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34214OtherTEXAS STATE BOARD OF PHARMACY