Provider Demographics
NPI:1043611031
Name:LATTIMORE, RUTH ANN BROWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUTH ANN
Middle Name:BROWN
Last Name:LATTIMORE
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 1:2241 ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5262
Mailing Address - Country:US
Mailing Address - Phone:336-789-7940
Mailing Address - Fax:
Practice Address - Street 1:2241 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5262
Practice Address - Country:US
Practice Address - Phone:336-789-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist