Provider Demographics
NPI:1356625057
Name:LATUS, JARED GREGORY (PHARMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:GREGORY
Last Name:LATUS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2178
Mailing Address - Country:US
Mailing Address - Phone:262-646-9095
Mailing Address - Fax:262-646-5125
Practice Address - Street 1:2901 GOLF RD
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2178
Practice Address - Country:US
Practice Address - Phone:262-646-9095
Practice Address - Fax:262-646-5125
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15499-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist