Healthcare Provider Details

I. General information

NPI: 1508107004
Provider Name (Legal Business Name): MATTHEW THOMPSON LENNICK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NE 137TH AVE
VANCOUVER WA
98682-4933
US

IV. Provider business mailing address

5717 NE 138TH AVE
PORTLAND OR
97230-3409
US

V. Phone/Fax

Practice location:
  • Phone: 503-250-1944
  • Fax:
Mailing address:
  • Phone: 503-250-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00051006
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0010269
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: