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NPI Code Detail

MEDICARE: MR. TIMOTHY GEORGE LARSEN R. PH.

MEDICARE: MR. TIMOTHY GEORGE LARSEN R. PH.
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
1183500000XPharmacistPH00009929WA

General Provider Information

NPI Number : 1881691079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY GEORGE LARSEN R. PH.
Provider Business Mailing Address
First Line : PO BOX 5120
Second Line :
City : YELM
State : WA
Zip : 98597-5120
Country : US
Telephone Number : 360-458-7110
Fax Number :
Provider Business Practice Location Address
First Line : 106 1ST ST S
Second Line :
City : YELM
State : WA
Zip : 98597-7700
Country : US
Telephone Number : 360-458-8467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 08/12/2013

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