Provider Demographics
NPI:1831286038
Name:LARRY H PAFFORD
Entity type:Organization
Organization Name:LARRY H PAFFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-696-5577
Mailing Address - Street 1:5 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-1708
Mailing Address - Country:US
Mailing Address - Phone:731-696-5577
Mailing Address - Fax:731-696-4311
Practice Address - Street 1:5 S COURT ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-1708
Practice Address - Country:US
Practice Address - Phone:731-696-5577
Practice Address - Fax:731-696-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TN104333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454946Medicaid
TN9440548Medicaid
4402258OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4402258OtherOTHER ID NUMBER-COMMERCIAL NUMBER