Provider Demographics
NPI:1952685273
Name:CALKINS, LARRY DUANE
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DUANE
Last Name:CALKINS
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 1:16685 ROSE BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8446
Mailing Address - Country:US
Mailing Address - Phone:208-465-4283
Mailing Address - Fax:208-463-4283
Practice Address - Street 1:8100 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8425
Practice Address - Country:US
Practice Address - Phone:208-375-2825
Practice Address - Fax:208-375-2846
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist