Provider Demographics
NPI:1033982616
Name:WILLIAMS, LATODRA (PHARMD, BCSCP)
Entity Type:Individual
Prefix:
First Name:LATODRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD, BCSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6124
Mailing Address - Country:US
Mailing Address - Phone:214-298-9141
Mailing Address - Fax:
Practice Address - Street 1:3130 CARMEL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6124
Practice Address - Country:US
Practice Address - Phone:214-298-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD190021835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations