Healthcare Provider Details

I. General information

NPI: 1619929684
Provider Name (Legal Business Name): LATTA DRUG COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MAIN ST
LATTA SC
29565-1617
US

IV. Provider business mailing address

106 E MAIN ST
LATTA SC
29565-1617
US

V. Phone/Fax

Practice location:
  • Phone: 843-752-0023
  • Fax: 843-752-0062
Mailing address:
  • Phone: 843-752-0023
  • Fax: 843-752-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50006173
License Number StateSC

VIII. Authorized Official

Name: BRYANT BROWN
Title or Position: OWNER PHCST
Credential: RPH
Phone: 843-752-0023