Provider Demographics
NPI:1154824902
Name:AULD, LARRY DON
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DON
Last Name:AULD
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 1:1000 E CARL ALBERT PKWY
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5121
Mailing Address - Country:US
Mailing Address - Phone:918-426-7657
Mailing Address - Fax:918-429-0794
Practice Address - Street 1:1000 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5121
Practice Address - Country:US
Practice Address - Phone:918-426-7657
Practice Address - Fax:918-429-0794
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist