Provider Demographics
NPI:1407278849
Name:SPRINGSTEEN, LARRY LEE (PHARMD AND PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:SPRINGSTEEN
Suffix:
Gender:M
Credentials:PHARMD AND PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RUTLAND SHOPPING PLZ
Mailing Address - Street 2:PRICE CHOPPER PHARMACY #131
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5201
Mailing Address - Country:US
Mailing Address - Phone:802-747-7887
Mailing Address - Fax:808-786-0926
Practice Address - Street 1:38 RUTLAND SHOPPING PLZ
Practice Address - Street 2:PRICE CHOPPER PHARMACY #131
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5201
Practice Address - Country:US
Practice Address - Phone:802-747-7887
Practice Address - Fax:808-786-0926
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0050658183500000X
NY053819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT053819OtherPHARMACIST LICENSE FROM STATE OF NEW YORK
VT033.0050658OtherPHARMACIST LICENCE NUMBER FOR STATE OF VERMONT