Provider Demographics
NPI:1740951102
Name:KAMMERER, LARA
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:KAMMERER
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 1:7 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-1344
Mailing Address - Country:US
Mailing Address - Phone:814-948-9732
Mailing Address - Fax:814-951-0163
Practice Address - Street 1:7 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714-1344
Practice Address - Country:US
Practice Address - Phone:814-948-9732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist