Individual
LATTANA TINA KETTAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
218 E MAIN ST, CLINTON, CT 06413-2230
(860) 664-4641
(860) 664-1632
Mailing address
92 STONEGATE RD, NEW BRITAIN, CT 06053-2649
(860) 830-2122
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0015656
CT
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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