Healthcare Provider Details

I. General information

NPI: 1710063342
Provider Name (Legal Business Name): LARRY MICHAEL MCGINNIS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

308 RIVER OAKS BLVD
SEARCY AR
72143-4541
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-6338
  • Fax:
Mailing address:
  • Phone: 501-286-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number6726
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: