MEDICARE: MR. LARRY LEE MYERS RP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8713	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2802773	OTHER	NE	NCPDP #

General Provider Information

NPI Number	:	1255306288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY LEE MYERS RP

Provider Business Mailing Address
First Line	:	73581 Q RD
Second Line	:	PO BOX 804
City	:	HOLDREGE
State	:	NE
Zip	:	68949-4139
Country	:	US
Telephone Number	:	308-995-5414
Fax Number	:	308-995-2051

Provider Business Practice Location Address
First Line	:	414 EAST AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-2215
Country	:	US
Telephone Number	:	308-995-5414
Fax Number	:	308-995-2051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	12/20/2019

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