Individual
MRS. LESA KEATON MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
412 LIBERTY ROAD, WEST LIBERTY, KY 41472
(606) 743-4957
Mailing address
534 RIGHT FORK LEWIS CREEK RD, MARTHA, KY 41159-8941
(606) 652-4331
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
010636
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010636
PHARMACISTS LICENSE
KY
Enumeration date
02/05/2007
Last updated
07/08/2007
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