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NPI Code Detail

MEDICARE: BRIDGET KELLY LARSON

MEDICARE:   BRIDGET KELLY LARSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03230132-2OH

General Provider Information

NPI Number : 1386925253
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET KELLY LARSON
Provider Business Mailing Address
First Line : 127 E PLEASANT VLY
Second Line :
City : SEVEN HILLS
State : OH
Zip : 44131-5601
Country : US
Telephone Number : 216-901-9782
Fax Number :
Provider Business Practice Location Address
First Line : 127 E PLEASANT VLY
Second Line :
City : SEVEN HILLS
State : OH
Zip : 44131-5601
Country : US
Telephone Number : 216-901-9782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2011
Last Update Date : 09/06/2011

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Directions to “ BRIDGET KELLY LARSON ” Practice Location

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