Healthcare Provider Details

I. General information

NPI: 1326378555
Provider Name (Legal Business Name): MATTHEW R STUMPF PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15385 N DYSART RD
EL MIRAGE AZ
85335-9761
US

IV. Provider business mailing address

15385 N DYSART RD
EL MIRAGE AZ
85335-9761
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-8248
  • Fax: 623-583-8370
Mailing address:
  • Phone: 623-583-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS013287
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: