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LARRY DEAN ANDERSON R.PH.

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1780619106

Individual Registrant:
 LARRY DEAN ANDERSON R.PH.
Gender: M
Sole Proprietor

Location and contact information for practice:
1003 WILLOW CREEK RD  PRESCOTT, AZ 86301-1641 US
Tel: 928-771-5364  Fax: 928-771-5502

Contact information for business:
2114 N ELDRED RD  CHINO VALLEY, AZ 86323-5212 US
Tel: 928-771-5364  Fax: 928-771-5502

Registration Information:
NPI: 1780619106
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
AZ8973

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
AZ PHARMACIST LICENSE8973AZ01




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