Provider Demographics
NPI:1396934337
Name:LARSON, SARAH MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MAE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 HIGHWAY 32 S
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-9163
Mailing Address - Country:US
Mailing Address - Phone:701-306-4746
Mailing Address - Fax:
Practice Address - Street 1:737 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4421
Practice Address - Country:US
Practice Address - Phone:701-234-6503
Practice Address - Fax:701-234-2405
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66070183500000X
MN117257183500000X
NDRPH4828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist