MEDICARE: MR. LARRY JOE RICH RPH.

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	PS27754	FL

General Provider Information

NPI Number	:	1538763669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY JOE RICH RPH.

Provider Business Mailing Address
First Line	:	3359 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3351
Country	:	US
Telephone Number	:	850-932-3581
Fax Number	:	850-932-8137

Provider Business Practice Location Address
First Line	:	3359 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3351
Country	:	US
Telephone Number	:	850-932-3581
Fax Number	:	850-932-8137

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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