Provider Demographics
NPI:1609896984
Name:OLIVER, LARRY WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WILLIAM
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S 120TH PL
Mailing Address - Street 2:STE 100
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5134
Mailing Address - Country:US
Mailing Address - Phone:425-687-4571
Mailing Address - Fax:
Practice Address - Street 1:3333 S 120TH PL
Practice Address - Street 2:STE 100
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5134
Practice Address - Country:US
Practice Address - Phone:425-687-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013746183500000X
UT150393-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist