Provider Demographics
NPI:1841333994
Name:LARSON, KARYL LEE (R PH)
Entity type:Individual
Prefix:
First Name:KARYL
Middle Name:LEE
Last Name:LARSON
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 7TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-5715
Mailing Address - Country:US
Mailing Address - Phone:605-886-8719
Mailing Address - Fax:
Practice Address - Street 1:122 E KEMP
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3640
Practice Address - Country:US
Practice Address - Phone:605-882-4809
Practice Address - Fax:605-882-5668
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist