Basic Information
| Provider Information | |||||||||
| NPI: | 1376543330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTHRIE | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | DEWAIN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RPH, CDM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1080 KNOX RDG | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306067044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065838337 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ATHENS VA OUTPATIENT CLINIC | ||||||||
| Address2: | 9249 HIGHWAY 29 NORTH | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306011400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062274548 | ||||||||
| FaxNumber: | 7062274538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH016103 | GA | X | Pharmacy Service Providers | Pharmacist | 1835P1200X | RPH016103 | GA | X | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.