Provider Demographics
NPI:1174097075
Name:VAN LAARHOVEN, MARY A (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:VAN LAARHOVEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2115
Mailing Address - Country:US
Mailing Address - Phone:303-710-7833
Mailing Address - Fax:
Practice Address - Street 1:2880 W HOLDEN PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3353
Practice Address - Country:US
Practice Address - Phone:303-953-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO192131835P1200X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy