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NPI Code Detail

MEDICARE: MR. LARRY EDWARD O'CONNOR RPH

MEDICARE: MR. LARRY EDWARD O'CONNOR RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist114866MN

General Provider Information

NPI Number : 1790052785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY EDWARD O'CONNOR RPH
Provider Business Mailing Address
First Line : 27 GROVELAND TERRACE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55403
Country : US
Telephone Number : 612-377-8382
Fax Number :
Provider Business Practice Location Address
First Line : 7135 EAST POINT DOUGLAS ROAD SOUTH
Second Line :
City : COTTAGE GROVE
State : MN
Zip : 55016-3014
Country : US
Telephone Number : 651-459-7015
Fax Number : 651-459-1922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2011
Last Update Date : 11/19/2011

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