Provider Demographics
NPI:1952663759
Name:LATTIMORE, LINDSEY P JR
Entity Type:Individual
Prefix:MR
First Name:LINDSEY
Middle Name:P
Last Name:LATTIMORE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 TYVOLA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3504
Mailing Address - Country:US
Mailing Address - Phone:704-501-2402
Mailing Address - Fax:704-501-2421
Practice Address - Street 1:500 TYVOLA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3504
Practice Address - Country:US
Practice Address - Phone:704-501-2402
Practice Address - Fax:704-501-2421
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist