Healthcare Provider Details

I. General information

NPI: 1477821726
Provider Name (Legal Business Name): LAURA L MATTINGLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PLUM ST
FRUITA CO
81521-2524
US

IV. Provider business mailing address

135 S PLUM ST
FRUITA CO
81521-2524
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-9508
  • Fax: 970-858-4685
Mailing address:
  • Phone: 970-858-9508
  • Fax: 970-858-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: