Provider Demographics
NPI:1023050846
Name:LAREAU, JOHN JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:LAREAU
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 1:2819 MAJESTY CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7529
Mailing Address - Country:US
Mailing Address - Phone:405-364-9512
Mailing Address - Fax:405-273-5236
Practice Address - Street 1:2819 MAJESTY CT
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-7529
Practice Address - Country:US
Practice Address - Phone:405-273-5236
Practice Address - Fax:405-273-2392
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist