Healthcare Provider Details

I. General information

NPI: 1982926143
Provider Name (Legal Business Name): DR. ERIK T MAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 DUPONT CIR STE 1
LOUISVILLE KY
40207-4806
US

IV. Provider business mailing address

3930 DUPONT CIR STE 1
LOUISVILLE KY
40207-4806
US

V. Phone/Fax

Practice location:
  • Phone: 502-894-4464
  • Fax: 502-636-8078
Mailing address:
  • Phone: 502-894-4464
  • Fax: 502-636-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17252
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012704
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: