Provider Demographics
NPI:1467603233
Name:GOOCH, LARRY CLARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:CLARK
Last Name:GOOCH
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 1:1616 N PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1034
Mailing Address - Country:US
Mailing Address - Phone:903-569-5343
Mailing Address - Fax:903-569-1320
Practice Address - Street 1:1616 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1034
Practice Address - Country:US
Practice Address - Phone:903-569-5343
Practice Address - Fax:903-569-1320
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist