Provider Demographics
NPI:1659889194
Name:LOSS, LARRYE ELLIS (PHARMD, MBA, RPH)
Entity Type:Individual
Prefix:DR
First Name:LARRYE
Middle Name:ELLIS
Last Name:LOSS
Suffix:
Gender:M
Credentials:PHARMD, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHIPMUNK LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4708
Mailing Address - Country:US
Mailing Address - Phone:610-565-8479
Mailing Address - Fax:610-565-8479
Practice Address - Street 1:1 MEDIMMUNE WAY
Practice Address - Street 2:101ORD/2236D
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2204
Practice Address - Country:US
Practice Address - Phone:301-398-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-030143-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP-030143-LOtherPHARMACIST LICENSE