Provider Demographics
NPI:1962648840
Name:LATTOUF, ASSAAD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ASSAAD
Middle Name:
Last Name:LATTOUF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GARRET CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1514
Mailing Address - Country:US
Mailing Address - Phone:973-653-5058
Mailing Address - Fax:
Practice Address - Street 1:3716 THIRD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2103
Practice Address - Country:US
Practice Address - Phone:718-992-1204
Practice Address - Fax:718-992-2501
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist