Provider Demographics
NPI:1255494415
Name:BOYETT, LARRY KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:KEITH
Last Name:BOYETT
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 1:11336 OLD HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:AXIS
Mailing Address - State:AL
Mailing Address - Zip Code:36505-4600
Mailing Address - Country:US
Mailing Address - Phone:251-675-5185
Mailing Address - Fax:
Practice Address - Street 1:MT. VERNON PHARMACY
Practice Address - Street 2:19390 HWY 43 & MILDRED ST.
Practice Address - City:MT. VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560
Practice Address - Country:US
Practice Address - Phone:251-829-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist