Individual
DR. LARRY JACK NEW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 LOGAN ST, WILLIAMSON, WV 25661-3608
(304) 235-3535
Mailing address
2596 FOREST HILLS RD, FOREST HILLS, KY 41527-8404
(606) 237-7539
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
013899
KY
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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