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General NPI Number Information
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NPI Number | 1477683365
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Entity Type | Individual
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Provider Name | ANGELA MARIE LARSON
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 03/20/2009
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Provider Practice Location Address
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Address Line | 1920 GRANT ST NW
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City | FARIBAULT
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State | MN
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Zip | 55021-4831
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Country | US
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Telephone | 507-334-1555
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Fax | 507-334-9030
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Provider Business Mailing Address
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Address Line | 1822 PRAIRIE AVE SW
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City | FARIBAULT
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State | MN
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Zip | 55021-5517
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Country | US
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Telephone | 507-332-6714
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Fax |
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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 | 117414
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License Number State | MN
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