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NPI Code Detail

MEDICARE: DR. MATTHEW CLAY SAMPLE PHARM.D.

MEDICARE: DR. MATTHEW CLAY SAMPLE PHARM.D.
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
1183500000XPharmacist15367OK

General Provider Information

NPI Number : 1679813802
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW CLAY SAMPLE PHARM.D.
Provider Business Mailing Address
First Line : 1500 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7214
Country : US
Telephone Number : 405-684-9764
Fax Number : 405-684-9751
Provider Business Practice Location Address
First Line : 1500 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7214
Country : US
Telephone Number : 405-684-9764
Fax Number : 405-684-9751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2013
Last Update Date : 05/20/2015

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