Provider Demographics
NPI:1437613460
Name:LABARGE, LIENNA (PHARMD)
Entity type:Individual
Prefix:
First Name:LIENNA
Middle Name:
Last Name:LABARGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27197 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2576
Mailing Address - Country:US
Mailing Address - Phone:586-344-1496
Mailing Address - Fax:
Practice Address - Street 1:27197 HICKORY ST
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-2576
Practice Address - Country:US
Practice Address - Phone:586-344-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist