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NPI Code Detail

MEDICARE: KAITLIN FERN LARSON PHARMD

MEDICARE: KAITLIN FERN 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
11835P0200XPediatric Pharmacist23100-40WI

General Provider Information

NPI Number : 1780536748
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLIN FERN LARSON PHARMD
Provider Business Mailing Address
First Line : W145N6701 CEDAR RIDGE LN
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-0941
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8915 W CONNELL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3067
Country : US
Telephone Number : 414-266-6538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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Directions to “ KAITLIN FERN LARSON PHARMD” Practice Location

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