Provider Demographics
NPI:1811643448
Name:LARSEN, RANEL ASHLEY (PHARM D)
Entity type:Individual
Prefix:
First Name:RANEL
Middle Name:ASHLEY
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4193 VEGA LOOP
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-5021
Mailing Address - Country:US
Mailing Address - Phone:916-799-5674
Mailing Address - Fax:
Practice Address - Street 1:4193 VEGA LOOP
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-5021
Practice Address - Country:US
Practice Address - Phone:916-799-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9538183500000X
CA58873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist