Provider Demographics
NPI:1073053013
Name:STIGER, LARRY JOE (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JOE
Last Name:STIGER
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 1:61 BELLE HELENE DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2526
Mailing Address - Country:US
Mailing Address - Phone:985-246-9170
Mailing Address - Fax:
Practice Address - Street 1:61 BELLE HELENE DR
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2526
Practice Address - Country:US
Practice Address - Phone:985-246-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist