Provider Demographics
NPI:1083699391
Name:LARISON, DEBORAH J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:LARISON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1202
Mailing Address - Country:US
Mailing Address - Phone:727-526-5769
Mailing Address - Fax:727-526-0899
Practice Address - Street 1:5420 9TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1202
Practice Address - Country:US
Practice Address - Phone:727-526-5769
Practice Address - Fax:727-526-0899
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37938183500000X, 1835P1200X, 1835P0018X
FLPU6115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS37938OtherFLROIDA PHARMACY LICENSE
FLPU6115OtherCONSULTANT PHARMACIST LIC