Provider Demographics
NPI:1629587837
Name:LATTA, KAITLIN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:A
Last Name:LATTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:OLDFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-8623
Practice Address - Country:US
Practice Address - Phone:802-626-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134211183500000X
NH04322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist