Provider Demographics
NPI:1407044563
Name:PLUNK, LARRY DOUGLAS SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DOUGLAS
Last Name:PLUNK
Suffix:SR
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 1:1948 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2762
Mailing Address - Country:US
Mailing Address - Phone:409-983-3384
Mailing Address - Fax:409-982-2826
Practice Address - Street 1:1948 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2762
Practice Address - Country:US
Practice Address - Phone:409-983-3384
Practice Address - Fax:409-982-2826
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0418Medicare PIN