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General NPI Number Information
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NPI Number | 1659889194
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Entity Type | Individual
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Provider Name | LARRYE ELLIS LOSS PHARMD, MBA, RPH
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Gender | Male
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 1 MEDIMMUNE WAY 101ORD/2236D
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City | GAITHERSBURG
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State | MD
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Zip | 20878-2204
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Country | US
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Telephone | 301-398-0132
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CHIPMUNK LN
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City | MEDIA
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State | PA
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Zip | 19063-4708
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Country | US
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Telephone | 610-565-8479
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Fax | 610-565-8479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP-030143-L
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License Number State | PA
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