MEDICARE: MATTHEW BLAKE LAWSON 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	46604	TN

General Provider Information

NPI Number	:	1750018099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BLAKE LAWSON PHARMD

Provider Business Mailing Address
First Line	:	1507 LINDEN AVE APT 17
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7379
Country	:	US
Telephone Number	:	606-335-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 S ROAN ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7675
Country	:	US
Telephone Number	:	423-979-0373
Fax Number	:

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

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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Directions to “ MATTHEW BLAKE LAWSON PHARMD” Practice Location

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