=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780783274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY MCQUADE KEARNS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 W UNIVERSITY PKWY
-----------------------------------------------------
City | OREM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84058-7316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-234-8510
-----------------------------------------------------
Fax | 801-234-8522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 E 150 N
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84062-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-234-8510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0141403-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------