Provider Demographics
NPI:1871887380
Name:MATTINGLY, TODD JOSEPH II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JOSEPH
Last Name:MATTINGLY
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 1:5614 HARRODS CV
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9350
Mailing Address - Country:US
Mailing Address - Phone:502-552-5104
Mailing Address - Fax:
Practice Address - Street 1:5614 HARRODS CV
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9350
Practice Address - Country:US
Practice Address - Phone:502-552-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0144931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist