Provider Demographics
NPI:1538455894
Name:LARSON, CHRISTOPHER LARRY NED (RPH)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LARRY NED
Last Name:LARSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3678
Mailing Address - Country:US
Mailing Address - Phone:715-362-8580
Mailing Address - Fax:715-362-0508
Practice Address - Street 1:2121 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3678
Practice Address - Country:US
Practice Address - Phone:715-362-8580
Practice Address - Fax:715-362-0508
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12768-040183500000X
AR041875183500000X
AZS017694183500000X
IL051-041003183500000X
KY013128183500000X
LA17832183500000X
NE12413183500000X
ND5036183500000X
ORRPH-0011952183500000X
TN23729183500000X
VA202209090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist