Individual
DR. JACOB R LARUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D., CGP, FASCP
Contact information
Practice address
3271 SIMEON BUNKER STREET, ST. CHARLES, MO 63301-8135
(573) 220-1208
Mailing address
3271 SIMEON BUNKER STREET, ST. CHARLES, MO 63301-8135
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2008021314
MO
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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