Provider Demographics
NPI:1194824284
Name:TORGUSON, LARRY A (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:A
Last Name:TORGUSON
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 1:5697 DIAMONDHEAD DR E
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3314
Mailing Address - Country:US
Mailing Address - Phone:228-255-5742
Mailing Address - Fax:228-255-5742
Practice Address - Street 1:5697 DIAMONDHEAD DR E
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3314
Practice Address - Country:US
Practice Address - Phone:228-255-5742
Practice Address - Fax:228-255-5742
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST08596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist