Provider Demographics
NPI:1902143837
Name:ALLEN, LATOSHA C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LATOSHA
Middle Name:C
Last Name:ALLEN
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 1:4670 LEBANON PIKE
Mailing Address - Street 2:PUBLIX PHARMACY
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1314
Mailing Address - Country:US
Mailing Address - Phone:615-874-2216
Mailing Address - Fax:615-874-2269
Practice Address - Street 1:4670 LEBANON PIKE
Practice Address - Street 2:PUBLIX PHARMACY
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1314
Practice Address - Country:US
Practice Address - Phone:615-874-2216
Practice Address - Fax:615-874-2269
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist