Provider Demographics
NPI:1952009425
Name:STAMPER, LARRY JR
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:STAMPER
Suffix:JR
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 1:4402 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BIG CHIMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4402 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BIG CHIMNEY
Practice Address - State:WV
Practice Address - Zip Code:25302-4700
Practice Address - Country:US
Practice Address - Phone:304-965-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT0011416183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician