Provider Demographics
NPI:1548549207
Name:LATCHAM, JENNIFER REESE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REESE
Last Name:LATCHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 US 70 HWY
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778
Mailing Address - Country:US
Mailing Address - Phone:828-686-7111
Mailing Address - Fax:828-686-7112
Practice Address - Street 1:2351 US 70 HWY
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778
Practice Address - Country:US
Practice Address - Phone:828-686-7111
Practice Address - Fax:828-686-7112
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0116950Medicaid