Provider Demographics
NPI:1790284610
Name:LARSEN, PATRICIA MOREHOUSE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MOREHOUSE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 LIME AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3101
Mailing Address - Country:US
Mailing Address - Phone:714-827-9837
Mailing Address - Fax:
Practice Address - Street 1:12444 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3930
Practice Address - Country:US
Practice Address - Phone:714-899-1520
Practice Address - Fax:714-899-1505
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist