Healthcare Provider Details

I. General information

NPI: 1831094143
Provider Name (Legal Business Name): LARRY JAMES HORTON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 N COUNTRY CLUB RD
ADA OK
74820-1899
US

IV. Provider business mailing address

123 WEST CHOCTAW AVE
ROFF OK
74865
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-2232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15546
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: