Provider Demographics
NPI:1487938064
Name:LANDO, LARISA (RPH)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:LANDO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CEDAR HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2138
Mailing Address - Country:US
Mailing Address - Phone:201-639-0123
Mailing Address - Fax:201-639-0125
Practice Address - Street 1:519 CEDAR HILL AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2138
Practice Address - Country:US
Practice Address - Phone:201-639-0123
Practice Address - Fax:201-639-0125
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02773500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist