Provider Demographics
NPI:1639533409
Name:TOLIVER, LARRY LYNN (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:LYNN
Last Name:TOLIVER
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:MERKEL
Mailing Address - State:TX
Mailing Address - Zip Code:79536-0156
Mailing Address - Country:US
Mailing Address - Phone:325-518-3947
Mailing Address - Fax:325-690-9720
Practice Address - Street 1:4565 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-1427
Practice Address - Country:US
Practice Address - Phone:325-690-9668
Practice Address - Fax:325-690-9720
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist