Provider Demographics
NPI:1679522056
Name:HOFFMAN, LARRY D
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-1634
Mailing Address - Country:US
Mailing Address - Phone:918-689-9940
Mailing Address - Fax:918-689-7557
Practice Address - Street 1:605 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-1634
Practice Address - Country:US
Practice Address - Phone:918-689-9940
Practice Address - Fax:918-689-7557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3724348OtherNCPDP
OK48-5037OtherPHARMACY LICENSE
OKBL9417925OtherDEA LICENSE