MEDICARE: LATTA J PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0000027818	TN

General Provider Information

NPI Number	:	1043830466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATTA J PATEL

Provider Business Mailing Address
First Line	:	3157 VISTA DR NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3691
Country	:	US
Telephone Number	:	423-413-1390
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 KEITH ST SW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5869
Country	:	US
Telephone Number	:	423-476-4539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2020
Last Update Date	:	04/26/2020

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Directions to “ LATTA J PATEL ” Practice Location

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