Provider Demographics
NPI:1861669491
Name:LARRY AUXIER
Entity Type:Organization
Organization Name:LARRY AUXIER
Other - Org Name:PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:606-723-5315
Mailing Address - Street 1:1220 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-7232
Mailing Address - Country:US
Mailing Address - Phone:606-723-5315
Mailing Address - Fax:606-723-8669
Practice Address - Street 1:1220 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7232
Practice Address - Country:US
Practice Address - Phone:606-723-5315
Practice Address - Fax:606-723-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP02013332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54022041Medicaid
2035136OtherPK
4781210001Medicare NSC
KY90006362OtherMEDICAID DME
KY1861669491OtherNPI