MEDICARE: DR. ALYSON ROSE LARSON PHARMD

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
1	183500000X	Pharmacist	120495	MN

General Provider Information

NPI Number	:	1528344835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSON ROSE LARSON PHARMD

Provider Business Mailing Address
First Line	:	211 FRAZEE ST E
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3503
Country	:	US
Telephone Number	:	218-847-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 FRAZEE ST E
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3503
Country	:	US
Telephone Number	:	218-847-3537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	01/24/2018

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