Provider Demographics
NPI:1053692244
Name:JUCHAU, LARRY (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:JUCHAU
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 1:6852 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-3004
Mailing Address - Country:US
Mailing Address - Phone:714-897-1695
Mailing Address - Fax:
Practice Address - Street 1:6852 ACACIA AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-3004
Practice Address - Country:US
Practice Address - Phone:714-897-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22191183500000X
IDP3185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist