Healthcare Provider Details

I. General information

NPI: 1023321874
Provider Name (Legal Business Name): THOMAS LATHAM WEST RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MLK JR HWY
ROSEBORO NC
28382
US

IV. Provider business mailing address

218 MLK JR HWY
ROSEBORO NC
28382
US

V. Phone/Fax

Practice location:
  • Phone: 910-525-5100
  • Fax: 910-525-4682
Mailing address:
  • Phone: 910-525-5100
  • Fax: 910-525-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006626
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: