Provider Demographics
NPI:1447549738
Name:FREE, LARRY MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MICHAEL
Last Name:FREE
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 1:4621 N SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6303
Mailing Address - Country:US
Mailing Address - Phone:770-455-4681
Mailing Address - Fax:
Practice Address - Street 1:4621 N SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6303
Practice Address - Country:US
Practice Address - Phone:770-455-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist