Provider Demographics
NPI:1073616587
Name:LARCORP INC
Entity Type:Organization
Organization Name:LARCORP INC
Other - Org Name:CEDAR HILL PRESCRIPTION SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:W
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-285-1900
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-0419
Mailing Address - Country:US
Mailing Address - Phone:636-285-1900
Mailing Address - Fax:636-285-4401
Practice Address - Street 1:7042 STATE RD BB
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016
Practice Address - Country:US
Practice Address - Phone:636-285-1900
Practice Address - Fax:636-285-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0048733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0573300001Medicare ID - Type Unspecified