Provider Demographics
NPI:1669819942
Name:LARSON, KEVIN ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:LARSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2936
Mailing Address - Country:US
Mailing Address - Phone:303-586-8417
Mailing Address - Fax:
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3917
Practice Address - Country:US
Practice Address - Phone:303-722-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0019597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist