Provider Demographics
NPI:1891452751
Name:BROWN, LATANYA VETA
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:VETA
Last Name:BROWN
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 1:10205 WASHINGTONIAN BLVD APT 543
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-8322
Mailing Address - Country:US
Mailing Address - Phone:301-332-0165
Mailing Address - Fax:
Practice Address - Street 1:1001 TWIN ARCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4138
Practice Address - Country:US
Practice Address - Phone:301-829-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT25645183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician