=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538455894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER LARRY NED LARSON R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2011
-----------------------------------------------------
Last Update Date | 06/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 LINCOLN ST
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-3678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-362-8580
-----------------------------------------------------
Fax | 715-362-0508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 LINCOLN ST
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-3678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-362-8580
-----------------------------------------------------
Fax | 715-362-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12768-040
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 041875
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S017694
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051-041003
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 013128
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17832
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12413
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5036
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH-0011952
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 23729
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 202209090
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------