Provider Demographics
NPI:1972706349
Name:OWEN, LARRY NOLAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:NOLAN
Last Name:OWEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1262
Mailing Address - Country:US
Mailing Address - Phone:330-343-5157
Mailing Address - Fax:
Practice Address - Street 1:3000 N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9469
Practice Address - Country:US
Practice Address - Phone:330-343-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-13230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist