Healthcare Provider Details

I. General information

NPI: 1265590533
Provider Name (Legal Business Name): MR. LARRY WALDROP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 49637186
  • Fax: 496371868267
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006277
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: