MEDICARE: JOEL C LARSON RPH

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	PR4360	ME

General Provider Information

NPI Number	:	1578897526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL C LARSON RPH

Provider Business Mailing Address
First Line	:	PO BOX 664
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-0664
Country	:	US
Telephone Number	:	207-862-4900
Fax Number	:	207-862-4398

Provider Business Practice Location Address
First Line	:	7 MAIN RD N
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1334
Country	:	US
Telephone Number	:	207-862-4900
Fax Number	:	207-862-4398

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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