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General NPI Number Information
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NPI Number | 1780302174
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Entity Type | Individual
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Provider Name | MATTHEW SMITH
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Gender | Male
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 609 19TH ST
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City | HONDO
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State | TX
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Zip | 78861-2504
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Country | US
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Telephone | 830-426-5312
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Fax |
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Provider Business Mailing Address
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Address Line | 1749 N FM 1049
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City | KNIPPA
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State | TX
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Zip | 78870-1027
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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 | 71069
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License Number State | TX
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