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General NPI Number Information
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NPI Number | 1851967913
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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 | 05/31/2021
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Last Update Date | 05/31/2021
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Provider Practice Location Address
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Address Line | 1400 SULPHUR SPRING RD
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City | HALETHORPE
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State | MD
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Zip | 21227-2701
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Country | US
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Telephone | 410-737-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 RIDGE DR
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City | BALTIMORE
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State | MD
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Zip | 21229-5353
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Country | US
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Telephone | 410-247-9354
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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 | T18255
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License Number State | MD
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