Provider Demographics
NPI:1982776209
Name:STRICKLAND, LARRY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:STRICKLAND
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 1:225 GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-2705
Mailing Address - Country:US
Mailing Address - Phone:361-528-2012
Mailing Address - Fax:361-528-2431
Practice Address - Street 1:225 GREEN AVE
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-2705
Practice Address - Country:US
Practice Address - Phone:361-528-2012
Practice Address - Fax:361-528-2431
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist