Healthcare Provider Details

I. General information

NPI: 1366073033
Provider Name (Legal Business Name): RICHARD A MATTHEW R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33021 GARFIELD RD
FRASER MI
48026-1800
US

IV. Provider business mailing address

33021 GARFIELD RD
FRASER MI
48026-1800
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-5012
  • Fax: 586-415-2230
Mailing address:
  • Phone: 586-293-5012
  • Fax: 586-415-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: