Provider Demographics
NPI:1558729632
Name:LATIF, MARY G (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:LATIF
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 1:8716 COBBLESTONE POINT CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4458
Mailing Address - Country:US
Mailing Address - Phone:469-363-7676
Mailing Address - Fax:
Practice Address - Street 1:8716 COBBLESTONE POINT CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4458
Practice Address - Country:US
Practice Address - Phone:469-363-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53385183500000X
TX39883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist