Individual
LATISHA NADINE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1589 KY HWY 15 SOUTH, JACKSON, KY 41339
(606) 666-2622
Mailing address
PO BOX 572, JACKSON, KY 41339-0572
(606) 207-6544
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
019090
KY
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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