Provider Demographics
NPI:1760134886
Name:HARPER, LARRY
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:HARPER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:18000 W 9 MILE RD STE 410
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4009
Mailing Address - Country:US
Mailing Address - Phone:248-395-6100
Mailing Address - Fax:
Practice Address - Street 1:18000 W 9 MILE RD STE 410
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4009
Practice Address - Country:US
Practice Address - Phone:248-395-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist