Active NPI
Benjamin Robert Larsen, PHARM D
- Pharmacist
- Yelm, WA
National Provider Identifier
1104078492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00055787
- Practice address
- 106 1St St S
Yelm, WA 98597-7700 - Phone
- (360) 458-8467
- NPI assigned
- Oct 17, 2008
- Last updated
- Oct 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00055787 | WA | Primary |
Addresses
Primary practice location
106 1St St S
Yelm, WA 98597-7700
Mailing address
PO Box 3097
11840 Bald Hills Rd SE
Yelm, WA 98597
Phone (360) 458-0634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00055787 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tim's Pharmacy & Gift Shop, LTD | Past | Accepting new patients | |
| Tim's Pharmacy & Gift Shop, LTD | Pharmacist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Long Term Care Pharmacy
- Yelm, WA
- NPI 1669066460
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224201600000",
"number": "1104078492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3097",
"address_2": "11840 BALD HILLS RD SE",
"city": "YELM",
"state": "WA",
"postal_code": "98597",
"telephone_number": "360-458-0634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 1ST ST S",
"city": "YELM",
"state": "WA",
"postal_code": "985977700",
"telephone_number": "360-458-8467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "BENJAMIN",
"middle_name": "ROBERT",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-17",
"last_updated": "2008-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00055787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yelm, WA
- Amanda Kroboth, M.A. CCC-SLP
- Barbarann Gabrielle Kuik, LMFTA, PHD-C
- La Vince Group, P.S Dba (Yelm Prairie Dental)
- Laboratory Corporation of America
- Miranda Elaine Lambert, M.S. CCC-SLP
- Timothy George Larsen, R. PH.
- Lavince Group PS (Yelm Prairie Dental)
- Hanna Elizabeth Lawlor
- Holley Lawrence
- Kaitlyn Elizabeth Leingang, MS, CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.