Provider Demographics
NPI:1194192534
Name:LARSEN, CRAIG ARTHUR II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ARTHUR
Last Name:LARSEN
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8618
Mailing Address - Country:US
Mailing Address - Phone:407-301-7901
Mailing Address - Fax:
Practice Address - Street 1:5997 STIRLING RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7225
Practice Address - Country:US
Practice Address - Phone:954-581-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist