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General NPI Number Information
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NPI Number | 1639419831
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Entity Type | Individual
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Provider Name | MATTHEW JAMES GRDGON CPHT
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Gender | Male
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 1301 2ND AVE SW SUITE 200
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City | LARGO
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State | FL
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Zip | 33770-3120
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Country | US
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Telephone | 727-581-9382
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Fax | 727-585-5818
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Provider Business Mailing Address
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Address Line | 1301 2ND AVE SW SUITE 200
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City | LARGO
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State | FL
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Zip | 33770-3120
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Country | US
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Telephone | 727-581-9382
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Fax | 727-585-5818
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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 | 049-181910
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | RPT4684
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License Number State | FL
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