Individual
JANE ELLEN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7235
(651) 982-7236
Mailing address
37422 HEARTHSIDE LN, NORTH BRANCH, MN 55056-4019
(651) 982-7235
(651) 982-7236
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1121292
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1121292
REGISTERED PHARMACIST
MN
Enumeration date
01/01/2007
Last updated
07/08/2007
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