Provider Demographics
NPI:1518244060
Name:LARSON, DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LARSON
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 1:2828 CHAD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7336
Mailing Address - Country:US
Mailing Address - Phone:541-342-5701
Mailing Address - Fax:541-285-2016
Practice Address - Street 1:2828 CHAD DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7336
Practice Address - Country:US
Practice Address - Phone:541-342-5701
Practice Address - Fax:541-285-2016
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR98121835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist