MEDICARE: LAURA L MATTINGLEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	15096	CO

General Provider Information

NPI Number	:	1477821726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L MATTINGLEY RPH

Provider Business Mailing Address
First Line	:	135 S PLUM ST
Second Line	:
City	:	FRUITA
State	:	CO
Zip	:	81521-2524
Country	:	US
Telephone Number	:	970-858-9508
Fax Number	:	970-858-4685

Provider Business Practice Location Address
First Line	:	135 S PLUM ST
Second Line	:
City	:	FRUITA
State	:	CO
Zip	:	81521-2524
Country	:	US
Telephone Number	:	970-858-9508
Fax Number	:	970-858-4685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	06/17/2026

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