Provider Demographics
NPI:1881355386
Name:DAVIS, LATOYA PATRICE (PHARMD)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:PATRICE
Last Name:DAVIS
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 1:228 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7003
Mailing Address - Country:US
Mailing Address - Phone:229-221-1140
Mailing Address - Fax:
Practice Address - Street 1:220 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3709
Practice Address - Country:US
Practice Address - Phone:229-221-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist