MEDICARE: MATTHEW THOMAS WEISSER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	IR60024675	WA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PH60291979	WA

General Provider Information

NPI Number	:	1073877270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW THOMAS WEISSER PHARMD

Provider Business Mailing Address
First Line	:	14218 92ND AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-8710
Country	:	US
Telephone Number	:	253-857-7797
Fax Number	:	253-857-7679

Provider Business Practice Location Address
First Line	:	14218 92ND AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-8710
Country	:	US
Telephone Number	:	253-857-7797
Fax Number	:	253-857-7679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	07/28/2022

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