Provider Demographics
NPI:1669754420
Name:ABRAHAM, LATASHA MONIQUE (PHARMD)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:MONIQUE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 SUGARLOAF DR
Mailing Address - Street 2:LOT 12
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-7548
Mailing Address - Country:US
Mailing Address - Phone:337-831-8185
Mailing Address - Fax:
Practice Address - Street 1:4828 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5214
Practice Address - Country:US
Practice Address - Phone:337-477-9068
Practice Address - Fax:447-477-4864
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist