Healthcare Provider Details

I. General information

NPI: 1821653536
Provider Name (Legal Business Name): MATTHEW A PICKERING RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW PICKERING PHARMACIST

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 CAMPBELL ST
BAKER CITY OR
97814-2221
US

IV. Provider business mailing address

3660 BIRCH ST
BAKER CITY OR
97814-1638
US

V. Phone/Fax

Practice location:
  • Phone: 541-523-2138
  • Fax:
Mailing address:
  • Phone: 801-830-8561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH001749
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: