Healthcare Provider Details

I. General information

NPI: 1831286038
Provider Name (Legal Business Name): LARRY H PAFFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S COURT ST
ALAMO TN
38001-1708
US

IV. Provider business mailing address

5 S COURT ST
ALAMO TN
38001-1708
US

V. Phone/Fax

Practice location:
  • Phone: 731-696-5577
  • Fax: 731-696-4311
Mailing address:
  • Phone: 731-696-5577
  • Fax: 731-696-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number104
License Number StateTN

VIII. Authorized Official

Name: LARRY H PAFFORD
Title or Position: OWNER / PHARMACIST
Credential:
Phone: 731-696-5577