Provider Demographics
NPI:1265552061
Name:KRUTHOFF, LARRY LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LEE
Last Name:KRUTHOFF
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 1:902 N HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1446
Mailing Address - Country:US
Mailing Address - Phone:712-464-3036
Mailing Address - Fax:712-464-8614
Practice Address - Street 1:101 N WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1723
Practice Address - Country:US
Practice Address - Phone:712-464-8811
Practice Address - Fax:712-464-8614
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14637OtherLICENSE NUMBER