Provider Demographics
NPI:1477821726
Name:MATTINGLEY, LAURA L (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MATTINGLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2934
Mailing Address - Country:US
Mailing Address - Phone:970-824-0155
Mailing Address - Fax:970-824-9782
Practice Address - Street 1:750 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2934
Practice Address - Country:US
Practice Address - Phone:970-824-0155
Practice Address - Fax:970-824-9782
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist