Individual
KEVIN LEANDER LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7051
Mailing address
5421 W 11310 N, HIGHLAND, UT 84003-3633
(801) 772-0366
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
153999-1701
UT
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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