Provider Demographics
NPI:1508156282
Name:SAMMONS, MATTHEW (PHARM D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ROBIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-9352
Mailing Address - Country:US
Mailing Address - Phone:614-370-7015
Mailing Address - Fax:
Practice Address - Street 1:716 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1357
Practice Address - Country:US
Practice Address - Phone:606-220-2553
Practice Address - Fax:606-220-2554
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist