Healthcare Provider Details

I. General information

NPI: 1285645184
Provider Name (Legal Business Name): LARRY'S PHARMACY OF SULPHUR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 W 2ND ST
SULPHUR OK
73086-4814
US

IV. Provider business mailing address

1012 W 2ND ST
SULPHUR OK
73086-4814
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-3131
  • Fax: 580-622-4578
Mailing address:
  • Phone: 580-622-3131
  • Fax: 580-622-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number554503
License Number StateOK

VIII. Authorized Official

Name: LARRY HOBBS
Title or Position: OWNER
Credential: DPH
Phone: 580-622-3131