Provider Demographics
NPI:1528387016
Name:HIBBS, LARRY DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DEAN
Last Name:HIBBS
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 1:101 WALNEY DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-1117
Mailing Address - Country:US
Mailing Address - Phone:724-282-3216
Mailing Address - Fax:724-625-3350
Practice Address - Street 1:101 WALNEY DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-1117
Practice Address - Country:US
Practice Address - Phone:724-282-3216
Practice Address - Fax:724-625-3350
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028995L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP028995LOtherSTATE PHARMACY LICENSE