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General NPI Number Information
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NPI Number | 1922440833
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Entity Type | Individual
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Provider Name | DR. JUAN CARLOS LATORRE
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Gender | Male
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 201 MARIARDEN RD
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City | DADEVILLE
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State | AL
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Zip | 36853-6244
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Country | US
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Telephone | 256-825-3237
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Fax | 256-825-3236
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Provider Business Mailing Address
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Address Line | 1718 DENALI CT
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City | AUBURN
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State | AL
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Zip | 36832-5103
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Country | US
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Telephone | 256-825-3237
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Fax | 256-825-3236
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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 | 16210
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License Number State | AL
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