Provider Demographics
NPI:1598864316
Name:LARSON, BRYAN S (PHARMD, BCPS, RPH)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:LARSON
Suffix:
Gender:M
Credentials:PHARMD, BCPS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 W 8090 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-1799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 S 2000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5820
Practice Address - Country:US
Practice Address - Phone:801-587-7917
Practice Address - Fax:801-581-7442
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368800-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist