Provider Demographics
NPI:1427340132
Name:LARSON, SUZANNE LINDA (RPH)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LINDA
Last Name:LARSON
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:PO BOX 1981
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98844-1981
Mailing Address - Country:US
Mailing Address - Phone:509-476-3159
Mailing Address - Fax:
Practice Address - Street 1:609 OMACHE DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9672
Practice Address - Country:US
Practice Address - Phone:509-826-2806
Practice Address - Fax:509-826-2808
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALARS0341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist