Provider Demographics
NPI:1932485646
Name:HAMEL, LARRY RAY JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:RAY
Last Name:HAMEL
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N BISBEE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1437
Mailing Address - Country:US
Mailing Address - Phone:520-384-4612
Mailing Address - Fax:520-384-0535
Practice Address - Street 1:650 N BISBEE AVE
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1437
Practice Address - Country:US
Practice Address - Phone:520-384-4612
Practice Address - Fax:520-384-0535
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist