Provider Demographics
NPI:1679871933
Name:LAUKE, LARRY DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DAVID
Last Name:LAUKE
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 1:703 S CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2019
Mailing Address - Country:US
Mailing Address - Phone:615-597-4200
Mailing Address - Fax:615-597-7003
Practice Address - Street 1:703 S CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2019
Practice Address - Country:US
Practice Address - Phone:615-597-4200
Practice Address - Fax:615-597-7003
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist