MEDICARE: MRS. DEIDRA MICHELLE MATTHEWS 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
1	183500000X	Pharmacist	19699	NC

General Provider Information

NPI Number	:	1750533139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEIDRA MICHELLE MATTHEWS PHARMD

Provider Business Mailing Address
First Line	:	2659 S NC 127 HWY
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-9129
Country	:	US
Telephone Number	:	828-294-7056
Fax Number	:	828-294-0125

Provider Business Practice Location Address
First Line	:	2659 S NC 127 HWY
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-9129
Country	:	US
Telephone Number	:	828-294-7056
Fax Number	:	828-294-0125

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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