Individual
GERALD DEOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
8820 RINEYVILLE RD, RINEYVILLE, KY 40162-9741
(270) 268-0259
Mailing address
8820 RINEYVILLE RD, RINEYVILLE, KY 40162-9741
(270) 268-0259
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
006077
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006077
KENTUCKY PHARMACIST LICENSE
KY
Enumeration date
09/11/2015
Last updated
09/11/2015
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