Provider Demographics
NPI:1568739712
Name:LARSON-HUNTER, CARLA JEANNE (RPH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEANNE
Last Name:LARSON-HUNTER
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 1:201 W MADISON
Mailing Address - Street 2:WALGREENS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:312-214-4385
Mailing Address - Fax:312-214-4479
Practice Address - Street 1:201 W MADISON ST
Practice Address - Street 2:WALGREENS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3317
Practice Address - Country:US
Practice Address - Phone:312-214-4385
Practice Address - Fax:312-214-4479
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist