Provider Demographics
NPI:1689809451
Name:LARSEN, LONNI LYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LONNI
Middle Name:LYN
Last Name:LARSEN
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 1:393 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2506
Mailing Address - Country:US
Mailing Address - Phone:617-776-7730
Mailing Address - Fax:617-776-2372
Practice Address - Street 1:393 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2506
Practice Address - Country:US
Practice Address - Phone:617-776-7730
Practice Address - Fax:617-776-2372
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist