Larry's Drive in Pharmacy, Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

SP0550784 Issued in WV

Legal business name

LARRY'S DRIVE IN PHARMACY, INC.

Practice address

313 Madison Ave
Madison, WV 25130-1510

Phone

(304) 369-0209

Fax

(304) 369-1994

NPI assigned

Jan 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Larry E Bowen

Title

Owner

Phone

(304) 369-0209

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740332782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301510",
            "telephone_number": "304-369-0209",
            "fax_number": "304-369-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301510",
            "telephone_number": "304-369-0209",
            "fax_number": "304-369-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY'S DRIVE IN PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-369-0209",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WV",
            "license": "SP0550784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143286000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Madison, WV
• Providers in Madison, WV by specialty
• Pharmacist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.