Healthcare Provider Details

I. General information

NPI: 1952557985
Provider Name (Legal Business Name): LATONYA RENA MENEFEE PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD BLDG 7
DALLAS TX
75216-7167
US

IV. Provider business mailing address

1580 MIRA LAGO BLVD APT 259
FARMERS BRANCH TX
75234-6090
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0592
  • Fax:
Mailing address:
  • Phone: 214-485-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17060
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: