Healthcare Provider Details

I. General information

NPI: 1790605012
Provider Name (Legal Business Name): MATTHEW GARRETT STOCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15075 LINCOLN ST APT 315
OAK PARK MI
48237-4117
US

IV. Provider business mailing address

15075 LINCOLN ST APT 315
OAK PARK MI
48237-4117
US

V. Phone/Fax

Practice location:
  • Phone: 248-818-1630
  • Fax:
Mailing address:
  • Phone: 248-818-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303050353
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: