Individual
JENNIFER LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1101 GRANTS PASS PKWY, GRANTS PASS, OR 97526-2333
(541) 474-7234
Mailing address
1101 GRANTS PASS PKWY, GRANTS PASS, OR 97526-2333
(541) 474-7234
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0014815
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0014815
OREGON BOARD OF PHARMACY LICENSE
OR
Enumeration date
10/07/2015
Last updated
10/07/2015
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