Provider Demographics
NPI:1205130549
Name:BARTOE, LARRY EDWARD (BS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:EDWARD
Last Name:BARTOE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:MOUNT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25637-1264
Mailing Address - Country:US
Mailing Address - Phone:304-239-2380
Mailing Address - Fax:304-239-2384
Practice Address - Street 1:US ROUTE 119 HOLDEN ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT GAY
Practice Address - State:WV
Practice Address - Zip Code:25637-1264
Practice Address - Country:US
Practice Address - Phone:304-239-2380
Practice Address - Fax:304-239-2384
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist