Provider Demographics
NPI:1881444032
Name:OJO, LARRY A
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:OJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522 CHICKAMAUGA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6372
Mailing Address - Country:US
Mailing Address - Phone:832-858-4757
Mailing Address - Fax:
Practice Address - Street 1:12410 MONTWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-1789
Practice Address - Country:US
Practice Address - Phone:915-500-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty