Provider Demographics
NPI:1750493094
Name:LARNER, DAVID MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:LARNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MELLADEE LN
Mailing Address - Street 2:
Mailing Address - City:MORRICE
Mailing Address - State:MI
Mailing Address - Zip Code:48857-9805
Mailing Address - Country:US
Mailing Address - Phone:517-410-8581
Mailing Address - Fax:
Practice Address - Street 1:111 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2819
Practice Address - Country:US
Practice Address - Phone:989-725-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist