Provider Demographics
NPI:1881005536
Name:LATTING, JUDY ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:LATTING
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 1:2591 E M 21
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1102
Mailing Address - Country:US
Mailing Address - Phone:989-743-2533
Mailing Address - Fax:989-743-2523
Practice Address - Street 1:2591 E M 21
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1102
Practice Address - Country:US
Practice Address - Phone:989-743-2533
Practice Address - Fax:989-743-2523
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI314064OtherNABP
MI5302024258OtherPHARMACIST LICENSE