Healthcare Provider Details

I. General information

NPI: 1801336375
Provider Name (Legal Business Name): MATTHEW BROWN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 PERRY WINKLE LN
HUNTINGTON WV
25702-9506
US

IV. Provider business mailing address

78 PERRY WINKLE LN
HUNTINGTON WV
25702-9506
US

V. Phone/Fax

Practice location:
  • Phone: 304-736-8310
  • Fax: 877-206-7137
Mailing address:
  • Phone: 304-736-8310
  • Fax: 877-206-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6180
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: