Provider Demographics
NPI:1932205788
Name:MASTIN, AMANDA BAKER (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BAKER
Last Name:MASTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PAYTEN LANE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744
Mailing Address - Country:US
Mailing Address - Phone:606-877-9587
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL DR
Practice Address - Street 2:SUITE 2 PARKWAY DRUG
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741
Practice Address - Country:US
Practice Address - Phone:606-330-1314
Practice Address - Fax:606-864-2600
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist