Provider Demographics
NPI:1902125362
Name:LARA, ORLANDO C
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:C
Last Name:LARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1525
Mailing Address - Country:US
Mailing Address - Phone:212-368-5511
Mailing Address - Fax:212-368-4334
Practice Address - Street 1:3750 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1525
Practice Address - Country:US
Practice Address - Phone:212-368-5511
Practice Address - Fax:212-368-4334
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040539-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist