Provider Demographics
NPI:1669193223
Name:MCCREVEN, LARA JOCELYN
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:JOCELYN
Last Name:MCCREVEN
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 1:90 LIBBEY INDUSTRIAL PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3130
Mailing Address - Country:US
Mailing Address - Phone:781-682-0630
Mailing Address - Fax:
Practice Address - Street 1:36 SHOPS AT 5 WAY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2677
Practice Address - Country:US
Practice Address - Phone:774-608-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241646183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist