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NPI Code Detail

MEDICARE: ANGELA MARIE LARSON

MEDICARE: ANGELA MARIE 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
1183500000XPharmacist117414MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477683365
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MARIE LARSON
Provider Business Mailing Address
First Line : 1822 PRAIRIE AVE SW
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-5517
Country : US
Telephone Number : 507-332-6714
Fax Number :
Provider Business Practice Location Address
First Line : 1920 GRANT ST NW
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-4831
Country : US
Telephone Number : 507-334-1555
Fax Number : 507-334-9030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 03/20/2009

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Directions to “ ANGELA MARIE LARSON ” Practice Location

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