Provider Demographics
NPI:1366726366
Name:REED, LATOSHA MONIQUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LATOSHA
Middle Name:MONIQUE
Last Name:REED
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 1:1657 COBBLESTONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4374
Mailing Address - Country:US
Mailing Address - Phone:314-803-1419
Mailing Address - Fax:
Practice Address - Street 1:7501 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-1602
Practice Address - Country:US
Practice Address - Phone:314-725-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007028945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist