Provider Demographics
NPI:1922100528
Name:MORRISON, LARRY KENT
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:KENT
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 GYPSUM HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2403
Mailing Address - Country:US
Mailing Address - Phone:703-754-4829
Mailing Address - Fax:703-361-5476
Practice Address - Street 1:8573 SUDLEY RD STE B
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3809
Practice Address - Country:US
Practice Address - Phone:703-361-1332
Practice Address - Fax:703-361-5476
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist