Provider Demographics
NPI:1225446388
Name:WEBER, LARRY (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:WEBER
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 1:1700 SE MEADOWBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1798
Mailing Address - Country:US
Mailing Address - Phone:509-525-3626
Mailing Address - Fax:509-525-3819
Practice Address - Street 1:1700 SE MEADOWBROOK BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1798
Practice Address - Country:US
Practice Address - Phone:509-525-3626
Practice Address - Fax:509-525-3819
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist