Provider Demographics
NPI:1265862213
Name:RAFFETY, LARISSA LOUISE (RP)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:LOUISE
Last Name:RAFFETY
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:LOUISE
Other - Last Name:LECHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5212 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845
Mailing Address - Country:US
Mailing Address - Phone:308-236-8547
Mailing Address - Fax:
Practice Address - Street 1:5212 3RD AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-236-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist