Individual
BRAD LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8770 S HOWELL AVE, OAK CREEK, WI 53154-7524
(414) 762-6770
Mailing address
8770 S HOWELL AVE, OAK CREEK, WI 53154-7524
(414) 762-6770
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12456-40
WI
Other
Enumeration date
12/09/2014
Last updated
12/09/2014
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