Healthcare Provider Details

I. General information

NPI: 1427481795
Provider Name (Legal Business Name): ERIN MARIE LATENDRESSE PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6098 DEBRA RD
CHATTANOOGA TN
37411-5702
US

IV. Provider business mailing address

2771 TANGLEWOOD DR
CHATTANOOGA TN
37415-6108
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP13018
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37451
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number37451
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number37451
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: