Provider Demographics
NPI:1033403985
Name:LARSON, JENNIFER LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
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 1:460 S VANCE ST
Mailing Address - Street 2:T-2717
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3305
Mailing Address - Country:US
Mailing Address - Phone:303-209-7750
Mailing Address - Fax:303-209-7760
Practice Address - Street 1:460 S VANCE ST
Practice Address - Street 2:T-2717
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3305
Practice Address - Country:US
Practice Address - Phone:303-209-7750
Practice Address - Fax:303-209-7760
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist