Healthcare Provider Details

I. General information

NPI: 1043220551
Provider Name (Legal Business Name): MATTHEW GARRETT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MONTOPOLIS DR
AUSTIN TX
78741
US

IV. Provider business mailing address

4903 CANYON CREST CT
AUSTIN TX
78735-6603
US

V. Phone/Fax

Practice location:
  • Phone: 512-389-6510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: