Provider Demographics
NPI:1447469028
Name:LARSON, ERIC JOHN JR (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:LARSON
Suffix:JR
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 1:2521 13TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4119
Mailing Address - Country:US
Mailing Address - Phone:407-892-7166
Mailing Address - Fax:407-892-0546
Practice Address - Street 1:2521 13TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4119
Practice Address - Country:US
Practice Address - Phone:407-892-7166
Practice Address - Fax:407-892-0546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist