Healthcare Provider Details

I. General information

NPI: 1215035969
Provider Name (Legal Business Name): LARRY'S FAMILY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SOUTH STATE ST.
PRESTON ID
83263
US

IV. Provider business mailing address

217 SOUTH STATE ST.
PRESTON ID
83263
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-0163
  • Fax: 208-852-1847
Mailing address:
  • Phone: 208-852-0163
  • Fax: 208-852-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1336CP
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4557
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1336CP
License Number StateID

VIII. Authorized Official

Name: MR. LARRY DURRANT
Title or Position: OWNER PHARMACIST
Credential: R.P.H
Phone: 435-563-6262