Provider Demographics
NPI:1164789616
Name:LYNN, LATOYA LATRICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:LATRICE
Last Name:LYNN
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 1:4601 MONTGOMERY HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1522
Mailing Address - Country:US
Mailing Address - Phone:334-340-1113
Mailing Address - Fax:334-340-1123
Practice Address - Street 1:4601 MONTGOMERY HWY STE 300
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1522
Practice Address - Country:US
Practice Address - Phone:334-340-1113
Practice Address - Fax:334-340-1123
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist