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 1:987 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9536
Mailing Address - Country:US
Mailing Address - Phone:303-359-9926
Mailing Address - Fax:
Practice Address - Street 1:987 VALLEY RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9536
Practice Address - Country:US
Practice Address - Phone:303-359-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist