Provider Demographics
NPI:1497412225
Name:DUTY, ELIJAH MATTHEW
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:MATTHEW
Last Name:DUTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1567
Mailing Address - Country:US
Mailing Address - Phone:606-465-7168
Mailing Address - Fax:
Practice Address - Street 1:8130 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1625
Practice Address - Country:US
Practice Address - Phone:740-574-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060003176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist