Provider Demographics
NPI:1659644862
Name:LANFERMAN, LARRY LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:LANFERMAN
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 1:3598 TAMI DR
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-3936
Mailing Address - Country:US
Mailing Address - Phone:707-497-7889
Mailing Address - Fax:707-441-0923
Practice Address - Street 1:1006 W WABASH AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2121
Practice Address - Country:US
Practice Address - Phone:707-441-0920
Practice Address - Fax:707-441-0923
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist