Provider Demographics
NPI:1720458318
Name:LARSEN, JEFFREY COLEMAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:COLEMAN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 UNIVERSITY BLVD NE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1728
Mailing Address - Country:US
Mailing Address - Phone:505-272-2341
Mailing Address - Fax:
Practice Address - Street 1:1131 UNIVERSITY BLVD NE
Practice Address - Street 2:SUITE G
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1728
Practice Address - Country:US
Practice Address - Phone:505-272-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81851835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist