Provider Demographics
NPI:1639491863
Name:SALYER, DUSTIN F (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:F
Last Name:SALYER
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 1:2945 SCOTTSVILLE RD
Mailing Address - Street 2:KMART PHARMACY
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6331
Mailing Address - Country:US
Mailing Address - Phone:270-782-1481
Mailing Address - Fax:
Practice Address - Street 1:2945 SCOTTSVILLE RD
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6331
Practice Address - Country:US
Practice Address - Phone:270-782-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014456183500000X
TN33791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist