Provider Demographics
NPI:1720318983
Name:MONSMAN, LARA S (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:S
Last Name:MONSMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 S STORMY LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2876
Mailing Address - Country:US
Mailing Address - Phone:724-699-4821
Mailing Address - Fax:
Practice Address - Street 1:1025 S MILTON RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6349
Practice Address - Country:US
Practice Address - Phone:928-779-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist