Healthcare Provider Details

I. General information

NPI: 1417517988
Provider Name (Legal Business Name): ZACHARY BRIAN TATE COMPTON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 N MAYO TRL
PIKEVILLE KY
41501-3210
US

IV. Provider business mailing address

691 BEECH CRK
PHELPS KY
41553-9018
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-0331
  • Fax:
Mailing address:
  • Phone: 606-984-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020630
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: