Provider Demographics
NPI:1720196827
Name:BARNETT, LARRY DUDLEY (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DUDLEY
Last Name:BARNETT
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 1:2390 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046-5102
Mailing Address - Country:US
Mailing Address - Phone:931-364-7715
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-327-5335
Practice Address - Fax:615-321-6310
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist