Provider Demographics
NPI:1912212580
Name:HAWE, LARRY EUGENE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EUGENE
Last Name:HAWE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 LINDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2256
Mailing Address - Country:US
Mailing Address - Phone:970-482-3654
Mailing Address - Fax:
Practice Address - Street 1:1512 LINDEN LAKE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2256
Practice Address - Country:US
Practice Address - Phone:970-482-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist