Healthcare Provider Details

I. General information

NPI: 1215934765
Provider Name (Legal Business Name): MATTHEW HAMBY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PROVIDENCE DR
ANCHORAGE AK
99508-4661
US

IV. Provider business mailing address

2419 LA HONDA DR
ANCHORAGE AK
99517-1343
US

V. Phone/Fax

Practice location:
  • Phone: 907-261-2502
  • Fax:
Mailing address:
  • Phone: 907-261-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1242
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: