Provider Demographics
NPI:1144459520
Name:PRUNTY, LARRY H (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:H
Last Name:PRUNTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBOURNE
Mailing Address - State:WV
Mailing Address - Zip Code:26149-9657
Mailing Address - Country:US
Mailing Address - Phone:304-758-2816
Mailing Address - Fax:304-758-4365
Practice Address - Street 1:300 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBOURNE
Practice Address - State:WV
Practice Address - Zip Code:26149-9657
Practice Address - Country:US
Practice Address - Phone:304-758-2816
Practice Address - Fax:304-758-4365
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist