Healthcare Provider Details

I. General information

NPI: 1356792337
Provider Name (Legal Business Name): MATTHEW FITZPATRICK PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 HIGH GREEN DR
STATHAM GA
30666-1673
US

IV. Provider business mailing address

1860 HIGH GREEN DR
STATHAM GA
30666-1673
US

V. Phone/Fax

Practice location:
  • Phone: 706-363-2256
  • Fax:
Mailing address:
  • Phone: 706-363-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029095
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: