Provider Demographics
NPI:1285645184
Name:LARRY'S PHARMACY OF SULPHUR INC
Entity Type:Organization
Organization Name:LARRY'S PHARMACY OF SULPHUR INC
Other - Org Name:LARRYS HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-622-3131
Mailing Address - Street 1:1012 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4814
Mailing Address - Country:US
Mailing Address - Phone:580-622-3131
Mailing Address - Fax:580-622-4578
Practice Address - Street 1:1012 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4814
Practice Address - Country:US
Practice Address - Phone:580-622-3131
Practice Address - Fax:580-622-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
OK5545033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100236130AMedicaid
2072610OtherPK
OK90003915386Medicaid
0509050002Medicare NSC