MEDICARE: LAUREL ANN LARSEN PHARMACIST

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	PS20567	FL

General Provider Information

NPI Number	:	1730939604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL ANN LARSEN PHARMACIST

Provider Business Mailing Address
First Line	:	1222 FORESTWOOD DRIVE
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677
Country	:	US
Telephone Number	:	727-480-3708
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 N HIMES AVE STE 105
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6228
Country	:	US
Telephone Number	:	877-581-5678
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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