Healthcare Provider Details

I. General information

NPI: 1043502255
Provider Name (Legal Business Name): MATTHEW KYLE PHILLIPS RPH,PHARMD,BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1663 SUNSET PARK DR
NOLENSVILLE TN
37135-9602
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4751
  • Fax:
Mailing address:
  • Phone: 931-580-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number34400
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: