Active NPI
Larry David Carruth Jr., R.PH.
- Pharmacist
- Mooresville, NC
National Provider Identifier
1073701561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14547
- Practice address
- 798 Oak Ridge Farm Hwy
Suite C
Mooresville, NC 28115-7923 - Phone
- (704) 658-9814
- Fax
- (704) 658-0721
- NPI assigned
- Oct 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14547 | NC | Primary |
| Pharmacist | 183500000X | 7720 | SC |
Addresses
Primary practice location
798 Oak Ridge Farm Hwy
Suite C
Mooresville, NC 28115-7923
Mailing address
121 Seabury Dr
Mooresville, NC 28117-6045
Phone (704) 904-5319
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14547 | Other | NC | NC LICENSE NUMBER |
| 7720 | Other | SC | SC LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14547 | NC | MD | Endodontist |
| 7720 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tall Oaks Pharmacy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Mooresville, NC
- NPI 1366468225
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191888000000",
"number": "1073701561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 SEABURY DR",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281176045",
"telephone_number": "704-904-5319",
"fax_number": "704-658-0721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "798 OAK RIDGE FARM HWY",
"address_2": "SUITE C",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281157923",
"telephone_number": "704-658-9814",
"fax_number": "704-658-0721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRUTH",
"first_name": "LARRY",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-09",
"last_updated": "2007-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "14547",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "7720",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC LICENSE NUMBER",
"identifier": "14547",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC LICENSE NUMBER",
"identifier": "7720",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.