Provider Demographics
NPI:1063012706
Name:TWEHUES, LARRY ANTHONY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ANTHONY
Last Name:TWEHUES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1084
Mailing Address - Country:US
Mailing Address - Phone:859-635-8822
Mailing Address - Fax:859-635-9419
Practice Address - Street 1:6711 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1084
Practice Address - Country:US
Practice Address - Phone:859-635-8822
Practice Address - Fax:859-635-9419
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY01471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist