Provider Demographics
NPI:1881091734
Name:OW, LARRY (RPH)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:OW
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 1:1320 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2109
Mailing Address - Country:US
Mailing Address - Phone:831-759-2163
Mailing Address - Fax:831-759-2198
Practice Address - Street 1:1320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2109
Practice Address - Country:US
Practice Address - Phone:831-759-2163
Practice Address - Fax:831-759-2198
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist