Provider Demographics
NPI:1912253634
Name:BERNARD, LARRY PAUL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:PAUL
Last Name:BERNARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1406
Mailing Address - Country:US
Mailing Address - Phone:541-482-8191
Mailing Address - Fax:866-267-6599
Practice Address - Street 1:2280 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1406
Practice Address - Country:US
Practice Address - Phone:541-482-8191
Practice Address - Fax:866-267-6599
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist