Provider Demographics
NPI:1578965919
Name:LARSON, THOMAS CHRISTOPHER JR (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:LARSON
Suffix:JR
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2150
Mailing Address - Country:US
Mailing Address - Phone:518-782-0227
Mailing Address - Fax:517-782-0261
Practice Address - Street 1:873 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2150
Practice Address - Country:US
Practice Address - Phone:518-782-0227
Practice Address - Fax:517-782-0261
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149174OtherNABP