Provider Demographics
NPI:1063500585
Name:WITTMEIER, LARRY JAMES (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:WITTMEIER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0917
Mailing Address - Country:US
Mailing Address - Phone:605-874-2036
Mailing Address - Fax:
Practice Address - Street 1:411 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226
Practice Address - Country:US
Practice Address - Phone:605-874-8220
Practice Address - Fax:605-874-8218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist