Provider Demographics
NPI:1104909464
Name:LATTOS, DAVID SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:LATTOS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 DRIFTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-2200
Mailing Address - Country:US
Mailing Address - Phone:608-786-9030
Mailing Address - Fax:866-764-4884
Practice Address - Street 1:550 DRIFTWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-2200
Practice Address - Country:US
Practice Address - Phone:608-786-9030
Practice Address - Fax:866-764-4884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12711OtherWISCONSIN DEPT OF REG