Individual
ANGELA MARIE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1920 GRANT ST NW, FARIBAULT, MN 55021-4831
(507) 334-1555
(507) 334-9030
Mailing address
1822 PRAIRIE AVE SW, FARIBAULT, MN 55021-5517
(507) 332-6714
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
117414
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106928000
—
MN
Enumeration date
03/07/2007
Last updated
03/20/2009
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