Individual
DJ KIMBALL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
3396 N STOCKTON HILL RD, KINGMAN, AZ 86409-3648
(928) 692-0444
(928) 692-6380
Mailing address
3956 HEATHER AVE, KINGMAN, AZ 86401-3842
(210) 386-3552
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S021334
AZ
Other
Enumeration date
09/22/2015
Last updated
08/15/2019
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