Provider Demographics
NPI:1174647176
Name:LARSON, AUGUST WILLIAM JR (RPH,PD)
Entity Type:Individual
Prefix:MR
First Name:AUGUST
Middle Name:WILLIAM
Last Name:LARSON
Suffix:JR
Gender:M
Credentials:RPH,PD
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH,PD
Mailing Address - Street 1:180 LAMP POST LN
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6209
Mailing Address - Country:US
Mailing Address - Phone:636-296-4606
Mailing Address - Fax:
Practice Address - Street 1:180 LAMP POST LN
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6209
Practice Address - Country:US
Practice Address - Phone:636-296-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist