Individual
MS. LEA MARIE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1430 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-1766
(541) 673-1750
Mailing address
1430 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-1766
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0013264
OR
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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