Provider Demographics
NPI:1881874386
Name:PAMMAL, LATHA
Entity type:Individual
Prefix:MRS
First Name:LATHA
Middle Name:
Last Name:PAMMAL
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 1:16 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6656
Mailing Address - Country:US
Mailing Address - Phone:631-940-5624
Mailing Address - Fax:631-549-1190
Practice Address - Street 1:391 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3203
Practice Address - Country:US
Practice Address - Phone:631-549-9592
Practice Address - Fax:631-549-1190
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist