Provider Demographics
NPI:1134412638
Name:LATIOLAIS, DAVID CARL (DPH,RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CARL
Last Name:LATIOLAIS
Suffix:
Gender:M
Credentials:DPH,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1818
Mailing Address - Country:US
Mailing Address - Phone:251-943-1588
Mailing Address - Fax:
Practice Address - Street 1:1255 S MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1818
Practice Address - Country:US
Practice Address - Phone:251-943-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16654183500000X
TN6390183500000X
TX21586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist