Provider Demographics
NPI:1881688653
Name:HIMMEGER, LARISSA MARIE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:MARIE
Last Name:HIMMEGER
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334-0242
Mailing Address - Country:US
Mailing Address - Phone:937-726-9844
Mailing Address - Fax:
Practice Address - Street 1:850 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-8906
Practice Address - Country:US
Practice Address - Phone:984-960-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33960183500000X
NC30937183500000X
OH03-1-17293183500000X
IN26023001A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist