Provider Demographics
NPI:1346681236
Name:BLACKBURN, MATTHEW (PHARMD, BCCCP, BCPS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:PHARMD, BCCCP, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 OLD FIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1724
Mailing Address - Country:US
Mailing Address - Phone:502-750-3338
Mailing Address - Fax:
Practice Address - Street 1:1000 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-0007
Practice Address - Country:US
Practice Address - Phone:859-323-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist