Individual
LARRY DEAN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 771-5364
(928) 771-5502
Mailing address
2114 N ELDRED RD, CHINO VALLEY, AZ 86323-5212
(928) 771-5364
(928) 771-5502
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8973
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8973
AZ PHARMACIST LICENSE
AZ
Enumeration date
07/12/2006
Last updated
07/08/2007
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