Provider Demographics
NPI:1518289305
Name:LATHAM, BARRY A (RPH)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:LATHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 AL HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7120
Mailing Address - Country:US
Mailing Address - Phone:256-753-9500
Mailing Address - Fax:256-753-9501
Practice Address - Street 1:8180 AL HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7120
Practice Address - Country:US
Practice Address - Phone:256-753-9500
Practice Address - Fax:256-753-9501
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12918OtherALA STATE BOARD OF PHARMACY