Provider Demographics
NPI:1528344835
Name:LARSON, ALYSON ROSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:ROSE
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 1:211 FRAZEE ST E
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3503
Mailing Address - Country:US
Mailing Address - Phone:218-847-3537
Mailing Address - Fax:
Practice Address - Street 1:211 FRAZEE ST E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3503
Practice Address - Country:US
Practice Address - Phone:218-847-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist