Provider Demographics
NPI:1467781351
Name:ELLIOTT, LARRY CHARLES (CPHT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:CHARLES
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:C
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:4315 DIPLOMACY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-2107
Mailing Address - Fax:907-729-2119
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-2107
Practice Address - Fax:907-729-2119
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK188183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician