Provider Demographics
NPI:1437473881
Name:BRADFORD, LARRY EMMETT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EMMETT
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W. JOE HARVEY
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-0801
Mailing Address - Country:US
Mailing Address - Phone:575-392-0053
Mailing Address - Fax:
Practice Address - Street 1:801 W. JOE HARVEY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0801
Practice Address - Country:US
Practice Address - Phone:575-392-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist