MEDICARE: MR. LARRY NOLAN OWEN 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	03-1-13230	OH

General Provider Information

NPI Number	:	1972706349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY NOLAN OWEN R.PH.

Provider Business Mailing Address
First Line	:	1100 JENNIFER DR
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-1262
Country	:	US
Telephone Number	:	330-343-5157
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N WOOSTER AVE
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-9469
Country	:	US
Telephone Number	:	330-343-5157
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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