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General NPI Number Information
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NPI Number | 1407996770
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Entity Type | Individual
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Provider Name | CRAIG DAVID LARSON RPH, PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 404 W FOUNTAIN
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City | ALBETA LEA
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State | MN
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Zip | 55060-4302
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Country | US
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Telephone | 507-301-3000
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Fax | 507-451-5134
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Provider Business Mailing Address
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Address Line | 1929 S CEDAR AVE STERLING DRUG
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City | OWATONNA
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State | MN
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Zip | 55060-4302
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Country | US
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Telephone | 507-451-0240
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Fax | 507-451-5134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 117665-8
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License Number State | MN
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