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General NPI Number Information
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NPI Number | 1144805102
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Entity Type | Individual
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Provider Name | MATTHEW STEWART GAITHER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 4331 THOUSAND OAKS DR
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City | SAN ANTONIO
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State | TX
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Zip | 78217-2101
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Country | US
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Telephone | 210-599-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 4003 N LOOP 1604 W APT 4104
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1782
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Country | US
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Telephone | 419-283-3194
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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 | 57728
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 59059
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License Number State | FL
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