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General NPI Number Information
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NPI Number | 1760531875
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Entity Type | Individual
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Provider Name | WILLIAM BRUCE LATIMER RPH
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3269 STOCKTON HILL RD KINGMAN REGIONAL MEDICAL CENTER - PHARMACY
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City | KINGMAN
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State | AZ
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Zip | 86409-3619
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Country | US
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Telephone | 928-575-0617
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Fax |
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Provider Business Mailing Address
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Address Line | 2856 CIMARRON WAY
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City | KINGMAN
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State | AZ
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Zip | 86401-7846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15612
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License Number State | AZ
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