DJ Kimball Larson, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

S021334 Issued in AZ

Practice address

3396 N Stockton Hill Rd
Kingman, AZ 86409-3648

Phone

(928) 692-0444

Fax

(928) 692-6380

NPI assigned

Sep 22, 2015

Last updated

Aug 15, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Walgreen Co

  dba Walgreens #03913

  • Pharmacy
  • Bullhead City, AZ
  • NPI 1942215280
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1629447412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3956 HEATHER AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864013842",
            "telephone_number": "210-386-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3396 N STOCKTON HILL RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093648",
            "telephone_number": "928-692-0444",
            "fax_number": "928-692-6380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "DJ",
        "middle_name": "KIMBALL",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-22",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S021334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "d0l03df.s02051@us.wal-mart.com",
            "affiliation": "N",
            "address_1": "3396 N Stockton Hill Rd",
            "city": "Kingman",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864093648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victoria M Laine, M.D.
• Robert Jordan Lakko, D.O.
• Lisa Marie Land, NP-C, ACNPC-AG
• Morgan Lang
• Braydon Larson, PHARMD
• Judith Mary Lassen, FNP
• Laurie'L Je'Mera Latimer, DO
• William Bruce Latimer, RPH
• Alana Sue Lauricella, RN
• Teague Lawrence, FNP-BC

• Pharmacist in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.