Provider Demographics
NPI:1790833796
Name:RAPER, LARRY EMMETT (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EMMETT
Last Name:RAPER
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 1:37376 FIFTH AVE
Mailing Address - Street 2:PO BOX 246
Mailing Address - City:SARDIS
Mailing Address - State:OH
Mailing Address - Zip Code:43946-0246
Mailing Address - Country:US
Mailing Address - Phone:740-483-1977
Mailing Address - Fax:
Practice Address - Street 1:155 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1330
Practice Address - Country:US
Practice Address - Phone:304-455-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist