MEDICARE: MR. LARRY LEROY WHIPPLE R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP031383L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15021699	OTHER	PA	DRIVERS LICENSE
2	RP031383L	OTHER	PA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1588778989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY LEROY WHIPPLE R.PH.

Provider Business Mailing Address
First Line	:	7888 CLEMENS RD
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-7608
Country	:	US
Telephone Number	:	814-438-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	7888 CLEMENS RD
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-7608
Country	:	US
Telephone Number	:	814-438-7454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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