Provider Demographics
NPI:1477929578
Name:LARSEN, DARCI (RPH)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1690
Mailing Address - Country:US
Mailing Address - Phone:719-543-5921
Mailing Address - Fax:719-543-7740
Practice Address - Street 1:1601 W US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1690
Practice Address - Country:US
Practice Address - Phone:719-543-5921
Practice Address - Fax:719-543-7740
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist