Provider Demographics
NPI:1669062568
Name:KOETT, LARRY (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:KOETT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 SADDLEBROOKE TRL
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4538
Mailing Address - Country:US
Mailing Address - Phone:270-993-9793
Mailing Address - Fax:
Practice Address - Street 1:4295 SADDLEBROOKE TRL
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4538
Practice Address - Country:US
Practice Address - Phone:800-426-8708
Practice Address - Fax:270-831-2496
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist