Provider Demographics
NPI:1669811857
Name:DAY, LARRY A (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:A
Last Name:DAY
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 1:609 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2040
Mailing Address - Country:US
Mailing Address - Phone:920-885-3277
Mailing Address - Fax:920-885-3570
Practice Address - Street 1:609 N SPRING ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2040
Practice Address - Country:US
Practice Address - Phone:920-885-3277
Practice Address - Fax:920-885-3570
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI040-10981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist