Provider Demographics
NPI:1760796692
Name:OWEN, LARRY RABORN (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:RABORN
Last Name:OWEN
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 1:4072 FENWICK LOOP
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1238
Mailing Address - Country:US
Mailing Address - Phone:251-533-2413
Mailing Address - Fax:
Practice Address - Street 1:9082 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5242
Practice Address - Country:US
Practice Address - Phone:251-649-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist