Provider Demographics
NPI:1760685614
Name:LARSEN, LARRY C (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:C
Last Name:LARSEN
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 1:244 NORTH MAIN STREET
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-0550
Mailing Address - Country:US
Mailing Address - Phone:701-444-2410
Mailing Address - Fax:701-444-2921
Practice Address - Street 1:244 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-0550
Practice Address - Country:US
Practice Address - Phone:701-444-2410
Practice Address - Fax:701-444-2921
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist