Provider Demographics
NPI:1558036533
Name:COMPTON, DEREK LANCE (RPH)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LANCE
Last Name:COMPTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 S MAYO TRL STE 102
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-2321
Mailing Address - Country:US
Mailing Address - Phone:606-432-2274
Mailing Address - Fax:606-433-9816
Practice Address - Street 1:1330 S MAYO TRL STE 102
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2321
Practice Address - Country:US
Practice Address - Phone:606-432-2274
Practice Address - Fax:606-433-9816
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist