Provider Demographics
NPI:1376543330
Name:GUTHRIE, LARRY DEWAIN JR (RPH, CDM)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DEWAIN
Last Name:GUTHRIE
Suffix:JR
Gender:M
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1080 KNOX RDG
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7044
Mailing Address - Country:US
Mailing Address - Phone:706-583-8337
Mailing Address - Fax:
Practice Address - Street 1:ATHENS VA OUTPATIENT CLINIC
Practice Address - Street 2:9249 HIGHWAY 29 NORTH
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1400
Practice Address - Country:US
Practice Address - Phone:706-227-4548
Practice Address - Fax:706-227-4538
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016103183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy