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NPI Code Detail

MEDICARE: DR. MATTHEW RYAN CRAVEN PHARMD

MEDICARE: DR. MATTHEW RYAN CRAVEN PHARMD
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
1183500000XPharmacist0000036059TN
2183500000XPharmacistRP0007757WV

General Provider Information

NPI Number : 1659657690
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW RYAN CRAVEN PHARMD
Provider Business Mailing Address
First Line : 902 ASHLEY RD
Second Line : BLDG 8 APT 50
City : JOHNSON CITY
State : TN
Zip : 37604-6481
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1805 W STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-8801
Country : US
Telephone Number : 423-929-1409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2011
Last Update Date : 10/21/2011

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