Itl Pharma

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

00004115 Issued in TN

Legal business name

ITL PHARMA

Practice address

100 Coley St
Kingsport, TN 37660-1505

Phone

(423) 444-1474

NPI assigned

Apr 2, 2015

Last updated

Apr 2, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keith R Latham

Title

Ceo

Phone

(423) 444-1474

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1154716512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COLEY ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376601505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COLEY ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376601505",
            "telephone_number": "423-444-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITL PHARMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-02",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "LATHAM",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-444-1474",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "00004115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laken N Ingle, COTA/L
• Ingles Markets Inc (Ingles Pharmacy #072)
• Amanda Davis Ingram, MD
• Genesia Dickson Irick, FNP
• Michael Itidiare, D.O., M.B.S
• Amanda R. Jackson, NP
• Brian Jackson
• Elizabeth Michele Jackson, M.D.
• Kelly Nicole Jackson, FNP
• Zachary Lynn Jackson

• Clinical Medical Laboratory in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Clinical Medical Laboratory in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.