Individual
MR. JONATHAN VICTOR VAN LARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
22777 W 11 MILE RD, SOUTHFIELD, MI 48034-2152
(248) 358-9160
Mailing address
1393 MOY AVENUE, WINDSOR, ONTARIO N8X 4-S5
(519) 253-0605
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302035070
MI
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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