Provider Demographics
NPI:1073910782
Name:LARKIN, G KEITH (PHARM D)
Entity Type:Individual
Prefix:
First Name:G
Middle Name:KEITH
Last Name:LARKIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5245
Mailing Address - Country:US
Mailing Address - Phone:479-458-0278
Mailing Address - Fax:479-452-2583
Practice Address - Street 1:8820 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5245
Practice Address - Country:US
Practice Address - Phone:479-458-0278
Practice Address - Fax:479-452-2583
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100390407Medicaid