Provider Demographics
NPI:1730821810
Name:COWART, LAKETHIA K (CPHT)
Entity type:Individual
Prefix:
First Name:LAKETHIA
Middle Name:K
Last Name:COWART
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 SPRINGTIME LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2936
Mailing Address - Country:US
Mailing Address - Phone:601-441-6695
Mailing Address - Fax:
Practice Address - Street 1:4946 SPRINGTIME LN
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2936
Practice Address - Country:US
Practice Address - Phone:601-441-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303040464183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician