Provider Demographics
NPI:1114363868
Name:LARSON, ANDREA N (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4001
Mailing Address - Country:US
Mailing Address - Phone:651-232-4800
Mailing Address - Fax:651-326-8151
Practice Address - Street 1:1390 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4001
Practice Address - Country:US
Practice Address - Phone:651-232-4800
Practice Address - Fax:651-326-8151
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN809415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist