Provider Demographics
NPI:1497163562
Name:LARSON, TONI (PHARMD)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 FELCH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2609
Mailing Address - Country:US
Mailing Address - Phone:616-748-3726
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST STE 200
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2609
Practice Address - Country:US
Practice Address - Phone:616-748-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213134183500000X
MI53020443261835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist