Provider Demographics
NPI:1669562609
Name:HADLEY, LARRY ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ALLEN
Last Name:HADLEY
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 1:30 HURSTLAND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4800
Mailing Address - Country:US
Mailing Address - Phone:502-695-3634
Mailing Address - Fax:502-695-3435
Practice Address - Street 1:1230 U.S. 127 SOUTH
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601
Practice Address - Country:US
Practice Address - Phone:502-875-2550
Practice Address - Fax:502-875-5094
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007364OtherPHARMACIST LICENSE NUMBER
KY54003579Medicaid