Individual
LARRY D CROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
51ST AVE AND BELTLINE RD, GILA CROSSING HEALTH CENTER PHARMACY POB 380, LAVEEN, AZ 85339-0380
(602) 528-1422
(602) 528-3363
Mailing address
PO BOX 380, GILA CROSSING HEALTH CENTER PHARMACY, LAVEEN, AZ 85339-0380
(602) 528-1422
(602) 528-3363
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11714
AZ
183500000X
Pharmacist
3812
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11714
PHARMACY LICENSE
AZ
01
—
3812
PHARMACY LICENSE
SD
Enumeration date
01/19/2007
Last updated
07/08/2007
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