Provider Demographics
NPI:1023133279
Name:MATHENY, LAINE HAWKINS (RPH)
Entity type:Individual
Prefix:MRS
First Name:LAINE
Middle Name:HAWKINS
Last Name:MATHENY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-5614
Mailing Address - Country:US
Mailing Address - Phone:828-245-3266
Mailing Address - Fax:828-657-5729
Practice Address - Street 1:1281 US HIGHWAY 221A
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-5921
Practice Address - Country:US
Practice Address - Phone:828-657-5353
Practice Address - Fax:828-657-5729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist