Provider Demographics
NPI:1174393425
Name:LATHAM, LORI LYN SMITH (PHARMD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LYN SMITH
Last Name:LATHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4721
Mailing Address - Country:US
Mailing Address - Phone:580-225-4418
Mailing Address - Fax:
Practice Address - Street 1:115 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4721
Practice Address - Country:US
Practice Address - Phone:580-225-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist