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General NPI Number Information
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NPI Number | 1093624322
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Entity Type | Individual
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Provider Name | MATTHEW ROBERT ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 575 STADIUM MALL DR
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City | WEST LAFAYETTE
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State | IN
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Zip | 47907-2091
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Country | US
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Telephone | 847-804-6351
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Fax |
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Provider Business Mailing Address
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Address Line | 712 FRANKLIN LN
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City | LINDENHURST
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State | IL
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Zip | 60046-4985
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 45024376A
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License Number State | IN
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