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Individual

DR. LARRYE ELLIS LOSS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHARMD, MBA, RPH

Contact information

Practice address
1 MEDIMMUNE WAY, 101ORD/2236D, GAITHERSBURG, MD 20878-2204
(301) 398-0132
Mailing address
20 CHIPMUNK LN, MEDIA, PA 19063-4708
(610) 565-8479
(610) 565-8479

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP-030143-L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RP-030143-L
PHARMACIST LICENSE
PA
Enumeration date
01/18/2018
Last updated
01/18/2018
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