Individual
KEITH LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 OVERLOOK LN NW, MANDAN, ND 58554-1594
(701) 663-5188
Mailing address
2600 OVERLOOK LN NW, MANDAN, ND 58554-1594
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3786
ND
Other
Enumeration date
06/24/2014
Last updated
06/24/2014
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