Provider Demographics
NPI:1477721884
Name:LEVY, LARRY BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:BRUCE
Last Name:LEVY
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 1:24 CARLING DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3721
Mailing Address - Country:US
Mailing Address - Phone:516-249-0275
Mailing Address - Fax:516-294-3763
Practice Address - Street 1:2305 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4709
Practice Address - Country:US
Practice Address - Phone:516-741-1510
Practice Address - Fax:516-248-2373
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30529OtherRPH STATE LICENSE NUMBER