Provider Demographics
NPI:1497038988
Name:CARRICO, MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:CARRICO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 HWY 11 NORTH
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314
Mailing Address - Country:US
Mailing Address - Phone:606-593-0382
Mailing Address - Fax:606-593-0384
Practice Address - Street 1:478 HWY 11 NORTH
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314
Practice Address - Country:US
Practice Address - Phone:606-593-0382
Practice Address - Fax:606-593-0384
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist