Provider Demographics
NPI:1407996770
Name:LARSON, CRAIG DAVID (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DAVID
Last Name:LARSON
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 S CEDAR AVE
Mailing Address - Street 2:STERLING DRUG
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4302
Mailing Address - Country:US
Mailing Address - Phone:507-451-0240
Mailing Address - Fax:507-451-5134
Practice Address - Street 1:404 W FOUNTAIN
Practice Address - Street 2:
Practice Address - City:ALBETA LEA
Practice Address - State:MN
Practice Address - Zip Code:55060-4302
Practice Address - Country:US
Practice Address - Phone:507-301-3000
Practice Address - Fax:507-451-5134
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117665-8183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN060858100Medicaid