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NPI Code Detail

MEDICARE: LARSEN SERVICE DRUG INC

MEDICARE: LARSEN SERVICE DRUG INC
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
13336L0003XLong Term Care Pharmacy
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPHAR163ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22071165OTHERPK

General Provider Information

NPI Number : 1568408581
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARSEN SERVICE DRUG INC
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : WATFORD CITY
State : ND
Zip : 58854-0550
Country : US
Telephone Number : 701-444-2410
Fax Number : 701-444-2921
Provider Business Practice Location Address
First Line : 244 N MAIN ST
Second Line :
City : WATFORD CITY
State : ND
Zip : 58854-7122
Country : US
Telephone Number : 701-444-2410
Fax Number : 701-444-2921
Authorized Official
Title or Position : PRESIDENT AND OWNER
Name : LARRY LARSEN
Credential : RPH
Telephone Number : 701-444-2410
Provider Enumeration Date : 06/20/2006
Last Update Date : 02/23/2016

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