Provider Demographics
NPI:1770184095
Name:TORRES RATLIFF, DEBORAH
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:TORRES RATLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SANDALWOOD TRL NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-5926
Mailing Address - Country:US
Mailing Address - Phone:228-238-7772
Mailing Address - Fax:
Practice Address - Street 1:527 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2217
Practice Address - Country:US
Practice Address - Phone:601-894-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist