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1598864316 NPI number — BRYAN S. LARSON PHARMD, BCPS, RPH

NPI Number: 1598864316
Health Care Provider/Practitioner: BRYAN S. LARSON PHARMD, BCPS, RPH

Information about “1598864316” NPI (BRYAN S. LARSON PHARMD, BCPS, RPH) exists in 1598864316 in HTML format HTML  |  1598864316 in plain Text format TXT  |  1598864316 in PDF (Portable Document Format) PDF  |  1598864316 in an XML format XML  formats.

NPI Number : 1598864316 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598864316",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LARSON",
    "FirstName": "BRYAN",
    "MiddleName": "S.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD, BCPS, RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4936 W 8090 S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST JORDAN",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84081-1799",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "30 S 2000 E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALT LAKE CITY",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84112-5820",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-587-7917",
    "PracticeLocationAddressFaxNumber": "801-581-7442",
    "EnumerationDate": "09/21/2006",
    "LastUpdateDate": "06/07/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "368800-1701",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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