Provider Demographics
NPI:1265602544
Name:KETCHUM, DAVID II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KETCHUM
Suffix:II
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 1:715 ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-7195
Mailing Address - Country:US
Mailing Address - Phone:573-359-1372
Mailing Address - Fax:573-359-3530
Practice Address - Street 1:946 E REED ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1243
Practice Address - Country:US
Practice Address - Phone:573-359-1372
Practice Address - Fax:573-359-3530
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045243183500000X, 1835P1200X
TN10463183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy