Provider Demographics
NPI:1790052785
Name:O'CONNOR, LARRY EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EDWARD
Last Name:O'CONNOR
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 1:27 GROVELAND TERRACE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:612-377-8382
Mailing Address - Fax:
Practice Address - Street 1:7135 EAST POINT DOUGLAS ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3014
Practice Address - Country:US
Practice Address - Phone:651-459-7015
Practice Address - Fax:651-459-1922
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist