Provider Demographics
NPI:1003245267
Name:LATIMER, NANETTE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:
Last Name:LATIMER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 LAKE EARL DR
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95532-0001
Mailing Address - Country:US
Mailing Address - Phone:707-465-1000
Mailing Address - Fax:707-465-9178
Practice Address - Street 1:5905 LAKE EARL DR
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95532-0001
Practice Address - Country:US
Practice Address - Phone:707-465-1000
Practice Address - Fax:707-465-9178
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist