Provider Demographics
NPI:1457497315
Name:HAAS, LARRY NEAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:NEAL
Last Name:HAAS
Suffix:
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 1:49 PYNGYP RD
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3711
Mailing Address - Country:US
Mailing Address - Phone:845-786-4012
Mailing Address - Fax:845-753-9675
Practice Address - Street 1:63 ORANGE TURNPIKE
Practice Address - Street 2:
Practice Address - City:STOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10980
Practice Address - Country:US
Practice Address - Phone:845-753-9675
Practice Address - Fax:845-753-2414
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038476OtherLISENCE