Healthcare Provider Details

I. General information

NPI: 1093040149
Provider Name (Legal Business Name): LARRY HOVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S 16TH ST
WILMINGTON NC
28401-8016
US

IV. Provider business mailing address

912 S 16TH ST
WILMINGTON NC
28401-8016
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-1896
  • Fax: 910-763-1709
Mailing address:
  • Phone: 910-763-1896
  • Fax: 910-763-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number05531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: