Healthcare Provider Details

I. General information

NPI: 1497827992
Provider Name (Legal Business Name): LARSON DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 10TH ST
CLARKFIELD MN
56223-1304
US

IV. Provider business mailing address

PO BOX 218
CLARKFIELD MN
56223-0218
US

V. Phone/Fax

Practice location:
  • Phone: 320-669-4621
  • Fax: 320-669-4621
Mailing address:
  • Phone: 320-669-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number200175
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH LARSON
Title or Position: PARTNER OWNER PHCST
Credential:
Phone: 320-669-4621