Provider Demographics
NPI:1366038705
Name:LOVENCE, LATISHA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:ANN
Last Name:LOVENCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 MACLAND RD SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4109
Mailing Address - Country:US
Mailing Address - Phone:770-499-7021
Mailing Address - Fax:
Practice Address - Street 1:1733 MACLAND RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4109
Practice Address - Country:US
Practice Address - Phone:770-499-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist