Provider Demographics
NPI:1497385652
Name:LARRY, KAREN GRAY (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GRAY
Last Name:LARRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3670
Mailing Address - Country:US
Mailing Address - Phone:817-297-0006
Mailing Address - Fax:
Practice Address - Street 1:1004 S CROWLEY RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3670
Practice Address - Country:US
Practice Address - Phone:817-297-0006
Practice Address - Fax:817-297-8776
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA142591835P0018X
TX306371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist