Provider Demographics
NPI:1588992291
Name:LARSON, CHARLES KEITH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:LARSON
Suffix:
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 1:800 N ZARAGOZA RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-2519
Mailing Address - Country:US
Mailing Address - Phone:915-860-1670
Mailing Address - Fax:915-860-0224
Practice Address - Street 1:800 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-2519
Practice Address - Country:US
Practice Address - Phone:915-860-1670
Practice Address - Fax:915-860-0224
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist