Individual
LARA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2440 WABASH AVE, TERRE HAUTE, IN 47807-3310
(812) 235-4322
Mailing address
2440 WABASH AVE, TERRE HAUTE, IN 47807-3310
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26025601A
IN
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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