Individual
THOMAS LEE MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
630 N CAROL MALONE BLVD, GRAYSON, KY 41143-1124
(606) 475-0033
Mailing address
630 N CAROL MALONE BLVD, GRAYSON, KY 41143-1124
(606) 475-0033
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8361
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8361
KENTUCKY BOARD OF PHARMACY
KY
Enumeration date
01/09/2022
Last updated
01/09/2022
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