Provider Demographics
NPI:1003236381
Name:BROWN, LARRY (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3429
Mailing Address - Country:US
Mailing Address - Phone:502-422-0605
Mailing Address - Fax:
Practice Address - Street 1:1860 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3429
Practice Address - Country:US
Practice Address - Phone:502-422-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007449183500000X
IN26013274A183500000X
NE14101183500000X
CA39176183500000X
MD21455183500000X
AZS019655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist