MEDICARE: MR. LARRY DOUGLAS PLUNK SR. R.PH.

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	05450	TX

General Provider Information

NPI Number	:	1407044563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY DOUGLAS PLUNK SR. R.PH.

Provider Business Mailing Address
First Line	:	1948 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2762
Country	:	US
Telephone Number	:	409-983-3384
Fax Number	:	409-982-2826

Provider Business Practice Location Address
First Line	:	1948 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2762
Country	:	US
Telephone Number	:	409-983-3384
Fax Number	:	409-982-2826

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/27/2008

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