Provider Demographics
NPI:1821085697
Name:SALYER, WANDA KATHLEEN (RPH)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:KATHLEEN
Last Name:SALYER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:SALYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1021 KY ROUTE 689
Mailing Address - Street 2:
Mailing Address - City:FLATGAP
Mailing Address - State:KY
Mailing Address - Zip Code:41219-9502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 N LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1270
Practice Address - Country:US
Practice Address - Phone:606-886-8106
Practice Address - Fax:606-886-8148
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9977183500000X
GA16277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist