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General NPI Number Information
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NPI Number | 1417325242
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Entity Type | Individual
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Provider Name | MATTHEW UTTER CPHT
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Gender | Male
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 13101 ALLEN RD SUITE 511
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City | SOUTHGATE
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State | MI
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Zip | 48195-2216
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Country | US
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Telephone | 734-374-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 20439 LAW AVE
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-5023
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Country | US
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Telephone | 313-418-6867
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303005268
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License Number State | MI
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