Provider Demographics
NPI:1295740710
Name:LARRYS APOTHECARY INC PGGOT DISCOUNT DRUGS
Entity type:Organization
Organization Name:LARRYS APOTHECARY INC PGGOT DISCOUNT DRUGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-5353
Mailing Address - Street 1:175 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-2028
Mailing Address - Country:US
Mailing Address - Phone:870-598-5353
Mailing Address - Fax:870-598-5353
Practice Address - Street 1:175 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2028
Practice Address - Country:US
Practice Address - Phone:870-598-5353
Practice Address - Fax:870-598-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR112273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136948OtherPK
0411227OtherNCPDP PROVIDER IDENTIFICATION NUMBER