Most Relevant Information
Provider Data
| NPI Number: | 1003219031 |
| Provider Name: | JODI ELAINE LARE BACHELOR OF PHARMACY |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 13111 |
Most Important Dates
| Enumeration Date: | 10/05/2014 |
| Last Updated: | 10/05/2014 |
Provider Practice Location
4370 MONTGOMERY RD
ELLICOTT CITY
MD
210436006
Practice Location Phone/Fax
| Phone: | 4102031212 |
| Fax: |
Provider Mailing Location
2022 WILTONWOOD RD
STEVENSON
MD
211530681
Provider Mailing Phone/Fax
| Phone: | 4104936228 |
| Fax: |