Provider Demographics
NPI:1609913128
Name:EARLE, BARRY ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:ANTHONY
Last Name:EARLE
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 1:420 GRAND OAK WAY
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9035
Mailing Address - Country:US
Mailing Address - Phone:864-574-4117
Mailing Address - Fax:
Practice Address - Street 1:420 GRAND OAK WAY
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-9035
Practice Address - Country:US
Practice Address - Phone:864-574-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC004558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist