Organization
LARRY R DISMORE
Active
Other names
LARRYS REXALL DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY DISMONE DPH (OWNER AND PHRMCST)
(580) 569-2008
Entity
Organization
Contact information
Practice address
616 E ST, SNYDER, OK 73566-1850
(580) 569-2008
(580) 569-4929
Mailing address
PO BOX 344, SNYDER, OK 73566-0344
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
41-2210
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235810A
—
OK
01
—
2073255
PK
—
Enumeration date
11/21/2005
Last updated
01/21/2016
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