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General NPI Number Information
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NPI Number | 1629051974
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Entity Type | Individual
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Provider Name | KENNETH DUANE LARSON R.PH.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 603 S CHESTNUT ST
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City | ELLENSBURG
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State | WA
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Zip | 98926-3875
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Country | US
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Telephone | 509-962-7329
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Fax | 509-962-7421
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Provider Business Mailing Address
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Address Line | 5671 MOUNTAIN LN
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City | PESHASTIN
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State | WA
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Zip | 98847-9765
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Country | US
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Telephone | 509-548-4903
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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 | PH00010753
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License Number State | WA
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