Larry R Dismore

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

41-2210 Issued in OK

Legal business name

LARRY R DISMORE

Practice address

616 E St
Snyder, OK 73566-1850

Phone

(580) 569-2008

Fax

(580) 569-4929

NPI assigned

Nov 21, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry Dismone, DPH

Title

Owner and Phrmcst

Phone

(580) 569-2008

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• LARRYS REXALL DRUG Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1235112699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "SNYDER",
            "state": "OK",
            "postal_code": "735660344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 E ST",
            "city": "SNYDER",
            "state": "OK",
            "postal_code": "735661850",
            "telephone_number": "580-569-2008",
            "fax_number": "580-569-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY R DISMORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-21",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "DISMONE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "OWNER AND PHRMCST",
        "authorized_official_telephone_number": "580-569-2008",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "41-2210",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100235810A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2073255",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LARRYS REXALL DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Snyder, OK
• Providers in Snyder, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.