Healthcare Provider Details

I. General information

NPI: 1073616587
Provider Name (Legal Business Name): LARCORP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7042 STATE RD BB
CEDAR HILL MO
63016
US

IV. Provider business mailing address

PO BOX 419
CEDAR HILL MO
63016-0419
US

V. Phone/Fax

Practice location:
  • Phone: 636-285-1900
  • Fax: 636-285-4401
Mailing address:
  • Phone: 636-285-1900
  • Fax: 636-285-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004873
License Number StateMO

VIII. Authorized Official

Name: MR. AUGUST W LARSON JR.
Title or Position: PRESIDENT
Credential: RPH
Phone: 636-285-1900