Provider Demographics
NPI:1063012052
Name:LARSEN, MARY JANELLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANELLE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 E HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:COAL HILL
Mailing Address - State:AR
Mailing Address - Zip Code:72832-8862
Mailing Address - Country:US
Mailing Address - Phone:479-279-7670
Mailing Address - Fax:479-974-2777
Practice Address - Street 1:1273 E HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:COAL HILL
Practice Address - State:AR
Practice Address - Zip Code:72832-8862
Practice Address - Country:US
Practice Address - Phone:479-279-7670
Practice Address - Fax:479-974-2777
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist