Provider Demographics
NPI:1750051975
Name:WOODHOUSE-LATTA, BERNADETTE LAVONNE (RPH)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:LAVONNE
Last Name:WOODHOUSE-LATTA
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 1:700 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6716
Mailing Address - Country:US
Mailing Address - Phone:912-354-4853
Mailing Address - Fax:
Practice Address - Street 1:700 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6716
Practice Address - Country:US
Practice Address - Phone:912-354-4853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist