Healthcare Provider Details

I. General information

NPI: 1417821141
Provider Name (Legal Business Name): MATTHEW GORDON ROUTHIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 SE COMMUNITY DR
STUART FL
34997-6420
US

IV. Provider business mailing address

5850 SE COMMUNITY DR
STUART FL
34997-6420
US

V. Phone/Fax

Practice location:
  • Phone: 772-324-3500
  • Fax:
Mailing address:
  • Phone: 772-324-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS59351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: